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: 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: 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: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when same-day physician or nurse practitioner appointments are unavailable. A meaningful proportion of emergency department visits involve conditions that could potentially be managed in primary care [1,2], and the Canadian Institute for Health Information reported that 15% of Canadian emergency department visits between April 2023 and March 2024 involved conditions that could potentially have been managed in primary care [3]. This article describes the Registered Nurse Prescriber-led Triage-Treatment-Continuity model developed at Cranston Ridge Medical Clinic in Calgary, Alberta, Canada. Methods: The manuscript is reported as a clinic-based practice innovation and service evaluation using aggregate, non-identifying operational service data. The model includes medical office assistant emergency recognition, RN prescriber-led structured triage, a traffic-light urgency classification system, a booking algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, and communication with the patient's primary care provider through the electronic medical record. No patient-identifiable information, patient-level chart review, interviews, surveys, biological samples, or experimental interventions were used. Under TCPS 2 Article 2.5, quality improvement and program evaluation activities conducted exclusively for assessment, management, or improvement purposes do not constitute research for that policy and do not fall within Research Ethics Board review [4]. Results: During a 12-month service evaluation period from April 2025 to April 2026, 5032 patient calls or encounters were managed through the RN prescriber-led pathway. These encounters are interpreted as internal urgent and semi-urgent primary care capacity and potential diversion, not as confirmed emergency department avoidance. Conclusions: The model reframes triage as an integrated primary care intervention rather than a passive sorting process. Further ethics-approved research is required to evaluate patient-level outcomes, safety events, comparative effectiveness, confirmed health-system utilization effects, and cost-effectiveness.