Background/Objectives: Western Canadian and U.S. communities outside urban centres remain underserved by primary, specialist, emergency, mental health, and chronic-disease services. These access problems reflect distance, weather, workforce shortages, specialist maldistribution, primary care attachment gaps, broadband limitations, and the governance realities of Indigenous and Tribal communities. This scoping review with narrative synthesis examined how telehealth and virtual-care models affect rural access in western Canada and the western/frontier United States. Methods: Searches were completed on 21 May 2026 in PubMed/MEDLINE, Embase, CINAHL, Scopus, the Cochrane Library, and PubMed Central. Supplementary searches included Google Scholar, publisher platforms, reference-list checking, and official Canadian and U.S. health-system sources. Peer-reviewed evidence published from 1 January 2016 to 21 May 2026 was eligible when it addressed rural, remote, frontier, Indigenous, underserved, western, or northern healthcare settings and reported access, implementation, safety, continuity, equity, or service-use outcomes. Results: The search identified 112 records; 27 duplicates were removed, 85 records were screened, 37 full texts were assessed, and 28 peer-reviewed records were included. Seven official sources were retained separately. Evidence was mainly observational, qualitative, mixed-methods, implementation-focused, or review-level. Moderate confidence supported telehealth for travel reduction and specialist input, especially through eConsultation, provider-to-provider consultation, telementoring, and real-time emergency support. Confidence was low to moderate for hybrid primary care and telemental health, and low for durable reductions in emergency department use. Conclusions: Telehealth may be most appropriately implemented as a hybrid, locally anchored, culturally safe access model, not as a stand-alone substitute for rural primary care, specialist capacity, or emergency services. Implementation should include broadband support, local physical assessment capacity, documentation, continuity, patient education, and clear escalation pathways.

Background/Objectives: Registered nurse (RN) prescribing is framed as a strategy to expand primary care access, but the safest, most useful, or most appropriate model may not be autonomous RN prescribing alone. Systematic review of the evidence on how best to understand RN prescribing with respect to collaborative models and supports, outcomes and effect modifiers, and implementation strategy, contingency factors, or conditions. Methods: Searches completed March 30, 2026, included PubMed/MEDLINE-indexed records; PubMed Central full-text records; Cochrane Library search interface; publisher platforms; reference chasing; and Canadian, Alberta government, and professional organization sources for Canadian regulatory, policy, and practice information. Peer-reviewed, eligible evidence comprised systematic reviews, randomized trials, cohort and cross-sectional studies, qualitative studies, mixed-methods studies, and implementation studies related to nurse prescribing, RN-led primary care, nurse-physician/NP collaboration, non-medical prescribing, medication titration, or primary-care team models. CASP-informed appraisal, AMSTAR 2 principles, and GRADE domains were used to rate the methodological quality and certainty. Results: A total of 286 records were identified; following de-duplication, title/abstract and full-text screening, 33 peer-reviewed records were included in the narrative synthesis; and four official contextual sources informed regulatory interpretation. Literature shows nurse, non-medical prescribing can achieve comparable or improved patient outcomes for blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol, medication adherence, satisfaction, and selected access outcomes. Conclusions: The strongest and most transferable model is coordinated RN prescribing, meaning embedded within a primary-care team in which family physicians and nurse practitioners remain available for diagnostic uncertainty, complex multimorbidity, high-risk prescribing, continuity, and escalation. Direct comparative evidence for this exact configuration is still limited, so future evaluations should test coordinated RN prescriber-FP/NP models using prospective implementation designs and patient-level outcomes.

Background/Objectives: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when timely appointments are unavailable. This article describes and evaluates the Cranston Ridge Medical Clinic Registered Nurse Prescriber-led Triage–Treatment–Continuity model in Calgary, Alberta, Canada. Methods: The manuscript is reported as a single-clinic practice innovation and service evaluation using aggregate, non-identifying operational data from 1 April 2025 to 31 March 2026. The model combines medical office assistant emergency recognition, RN prescriber-led stability assessment, traffic-light urgency classification, a booking-contingency algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, safety-netting, and communication with the patient’s primary care provider through the electronic medical record. Results: During the evaluation period, 5032 pathway contacts were managed. Of 5030 stable contacts assigned traffic-light categories, 4950 (98.4%) were Code Red same-day contacts, 55 (1.1%) were Code Yellow 24–48-h contacts, and 25 (0.5%) were Code Green non-urgent contacts. Two contacts triggered EMS/911 activation before traffic-light classification. Following RN prescriber assessment, 9 emergency department referrals, 2 urgent care referrals, 85 primary care provider follow-up appointments, and 5 patient refusals were recorded; no safety incidents or complaints were recorded in the aggregate monitoring dataset. A CIHI-informed 15% reference scenario corresponds to approximately 755 potentially avoided ED/UCC visits, but no confirmed diversion or monetary savings are claimed. Conclusions: The model reframes triage as an integrated primary care intervention that combines assessment, treatment, escalation, and continuity. Further ethics-approved research is required to evaluate patient-level outcomes, safety, confirmed health-system utilization effects, stakeholder experience, and cost-effectiveness.

Background/Objectives: Registered nurse (RN) prescribing can improve timely access to care, but only when the education, authorization process, and workplace supports match the clinical responsibility being given to the nurse. This policy and practice analysis compares Alberta, Canada, with Aotearoa New Zealand, with particular attention to New Zealand registered nurse prescribers in primary health and specialty teams and to RN prescribing as a possible bridge to nurse practitioner (NP) readiness. Methods: We reviewed publicly available legislation, regulator standards, educational frameworks, professional guidance, and institutional information from Alberta/Canada and Aotearoa New Zealand. We also use the publicly described Cranston Ridge Medical Clinic RN Prescriber Internship as an illustrative family-medicine model. No patient, staff, trainee, or private programme data were collected. Results: Alberta permits eligible RNs, when authorized by the College of Registered Nurses of Alberta, to prescribe Schedule 1 drugs, except controlled drugs and substances, and to order common diagnostic tests within a specific practice setting and location. New Zealand uses a postgraduate, practicum-based designated-prescriber pathway for registered nurse prescribers in primary health and specialty teams, with ongoing requirements for prescribing-related professional development and prescribing practice. New Zealand also embeds registered nurse prescribing programme outcomes within NP education standards. Conclusions: Alberta appears to have an enabling legal architecture, but current implementation is site-specific and not formally linked to NP education. We propose a hybrid Alberta-New Zealand-CRMC model built around portable regulator-recognised RN-prescriber authorization, postgraduate prescribing sciences, supervised family-medicine entrustment, employer onboarding, and formal bridging into NP education. The model is presented for policy debate and future evaluation, not as an already tested outcome intervention.

Background/Objectives: Western Canadian and US communities beyond urban centres are routinely underserved by primary, specialist, and emergency care services, whether based in rural, remote, frontier or Indigenous settings. Access issues in these contexts have traditionally been framed by distance, weather, and clinician availability challenges, but also extend to specialist maldistribution, attachment gaps and uneven broadband availability. This systematic review and narrative evidence synthesis scoped the impact of telehealth and other virtual-care models on rural access to services, broadly construed to include timely access, travel burden, specialist input, emergency support, continuity and clinician support, safety, and equity, or impacts on service fairness and effectiveness. Methods: Searches conducted in May 2026 included PubMed/MEDLINE-indexed records, PubMed Central full-text records, the Cochrane Library search interface, publisher platforms, reference chasing, and official sources from Canadian and US health systems. Eligible evidence from 1 January 2016 through 6 May 2026 addressed rural, remote, frontier, Indigenous, underserved, western or northern health-service settings, with earlier landmark sources retained for historical framing where relevant. Results: The search identified 112 records; after de-duplication and screening, 28 eligible peer-reviewed records were included in the evidence synthesis and 7 official sources informed jurisdictional contextualization. Evidence supported virtual care as an access extender in contexts where it can reduce travel, enable specialist input or support rural clinicians, maintain continuity of chronic disease or mental health follow-up. Virtual care is best when paired with on-site physical assessment and in-person escalation pathways. Evidence was weaker for virtual-only models, and for durable effects on emergency department use. Conclusions: Telehealth should therefore be implemented as a hybrid, locally anchored, culturally safe access model rather than as a stand-alone substitute for rural primary care or specialist capacity.

Background/Objectives: Registered nurse (RN) prescribing is increasingly discussed as a strategy to improve primary-care access, medication follow-up, chronic disease management, and service responsiveness. The available evidence, however, does not directly test a single coordinated RN prescriber–family physician/nurse practitioner (FP/NP) model. This integrative review synthesized heterogeneous evidence relevant to how RN prescribing may be organized within team-based primary care. Methods: A structured integrative review approach was used to map evidence from nurse and non-medical prescribing, RN-led primary care, nurse–physician substitution, interprofessional collaboration, chronic disease medication titration, patient-experience, and implementation research. Searches completed on 30 March 2026 included PubMed/MEDLINE, PubMed Central, the Cochrane Library search interface, publisher full-text platforms, targeted scholarly searches, citation chasing, and Canadian regulatory/professional sources. Methodological quality was appraised using AMSTAR 2- and CASP-informed criteria, and the strength of interpretation was assessed narratively. No meta-analysis was performed because of substantial heterogeneity and the risk of double-counting primary studies included in prior evidence syntheses. Results: A total of 286 records were identified. After de-duplication, screening, and eligibility assessment, 37 peer-reviewed records were included: 30 review-level or evidence-synthesis records and 7 primary, mixed-methods, or patient-experience studies. Four official regulatory/professional sources were retained separately for context. Nurse and non-medical prescribing were generally associated with comparable or favourable outcomes for blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol, medication adherence, patient satisfaction, and selected access outcomes in defined contexts. Direct evidence for the exact RN prescriber–FP/NP configuration remains limited. Conclusions: Current evidence is consistent with a coordinated RN prescribing model embedded within primary-care teams, but does not establish causal superiority of this configuration over other models. Coordinated RN prescribing should therefore be understood as an evidence-informed and testable implementation model requiring prospective evaluation, particularly for diagnostic safety, adverse events, continuity, workload, cost, and patient-level outcomes.