Volume twenty-six, Issue 4

Rheumatic diseases can significantly impair quality of life if not recognised early. In remote areas with limited healthcare access, physicians require appropriate competencies to manage these conditions effectively. Entrustable professional activities (EPAs) translate competencies into assessable clinical practice, but their use in rheumatology remains limited. This Original Research study presents a consensus-based list of essential EPAs for young physicians to improve rheumatic care in underserved regions.

Primary healthcare workers and services are increasingly insufficient to meet demand in the Northern Territory (NT), Australia, particularly in very remote areas. Digital health technologies (DHTs), such as telehealth, may improve access to comprehensive primary health care, but their success depends on meeting local needs and involving users in their design and implementation. This Original Research study examines preferences for DHT attributes among Aboriginal community members in a very remote Top End community and primary healthcare providers working in the NT.

Technological advancements over the past two decades have made ultrasound devices more portable, affordable, and user-friendly, facilitating increased use of bedside point-of-care ultrasound (PoCUS) by clinicians, including family physicians (FPs). FPs skilled in PoCUS can access additional information that would not have been immediately available otherwise, potentially increasing their diagnostic certainty. Although clinical studies from several high-income countries have evaluated the usefulness of PoCUS for FPs, there is a need for this type of evidence from rural Canada. This Short Communication reports on the extent to which PoCUS affects FPs’ diagnostic certainty and their clinical decision-making in rural British Columbia.

Approximately 70% of Kenya's population resides in rural areas, where shortages of health personnel are severe. Rural healthcare workers face high workloads, stock-outs of essential medications, and inadequate infrastructure, and compromised wellbeing among healthcare workers further threatens service delivery and the continuity of care. This Original Research study explores the relationships among happiness, health status, and motivation for healthcare workers in rural Kenya.

Open defecation is common in areas where sanitation infrastructure remains a critical public health challenge in Sub-Saharan Africa. In Nigeria, despite national commitments to achieve open defecation-free status by 2030, progress remains slow, particularly in rural areas. This Original Research study explicitly examines the knowledge–practice gap in hygiene and defecation behaviours, household economic decision-making regarding sanitation investments, child faeces management practices, and environmental factors affecting latrine feasibility.

Although rural populations account for nearly half the world’s population, many rural communities continue to face substantial barriers to accessing quality health care, largely due to shortages and maldistribution of qualified health professionals. One strategy that countries have invested in to improve the attraction and retention of qualified physicians in rural areas is exposure to rural practice during medical training. This Scoping Review identifies and synthesizes the literature on the educational, professional, and service-related effects of rural medical internships undertaken during undergraduate medical education, including their reported contribution to healthcare delivery in rural communities.

In Japan, health care and education are considered basic rights to which all individuals should have equitable access. However, while even small rural towns usually have schools and teachers, many rural areas have a shortage of physicians, resulting in substantial regional disparities in access to health care. This Original Research study examines the distribution of physicians and teachers in Japan and explores what this can tell us about providing essential services more equitably.

Because uncertainty is an unavoidable feature of rural and remote health planning, planners are frequently required to make infrastructure and service decisions based on partial information, proxy indicators or qualitative judgement rather than on comprehensive empirical evidence. To manage uncertainty, health planning reports commonly include sensitivity analyses, which may provide reassurance without fully clarifying the conditions that determine the preferred option. This Commentary argues that reporting reversal thresholds – the values at which a planning conclusion would no longer hold – offers a simple but powerful complement to existing practice. By making these thresholds explicit, analysts can improve the transparency, credibility and usefulness of planning analyses in remote settings.

Many rural Australian communities are facing ongoing critical health workforce shortages, exacerbating already low rates of healthcare access compared with metropolitan areas. Future shortages appear likely because many Australian healthcare workers intend to retire early due to burnout, psychological distress, long working hours, budget cuts, or workforce retention issues. Little is known about the latent capacity of healthcare workers already living in rural communities who are unemployed, working casually or part-time, or otherwise not participating in the workforce to the extent they may be willing or able to sustain. This Original Research study investigates the barriers and enablers to increasing the participation, recruitment, and retention of underemployed rural healthcare workers in Australia.

Globally, the needs of children with developmental disabilities have often been overlooked in health systems planning and policy provision. Parents and families of children with developmental disabilities navigate extremely complex health, education, and social systems to secure a safe and supportive environment for their children. In  Kenya, caregivers face barriers including long distances to healthcare facilities, perceived discrimination, lack of physiotherapist services, and inadequate scheduling of appointments, and all of these barriers are intensified for families in rural and remote areas. This Original Research article examines how primary caregivers of children with developmental disabilities navigate healthcare systems in rural Kenya.

Canada is facing a primary care crisis, with rural areas being disproportionately affected by physician shortages. Internationally trained physicians (ITPs) have become essential to addressing rural workforce shortages and constitute more than 80% of rural physicians in Saskatchewan. Given their central role in rural healthcare delivery, understanding ITPs' perceptions of workload sustainability is essential for informing workforce planning, physician wellbeing, and long-term rural retention. The Saskatchewan International Physician Practice Assessment (SIPPA) program offers a unique opportunity to explore ITP experiences. This Original Research study explores how specific workload demands influence self-reported sustainability among SIPPA-participating ITPs.

Type 2 diabetes is a key modifiable risk factor for cardiovascular disease, and the best outcomes are achieved with early diagnosis and management to prevent health complications. However, managing diabetes in remote areas is challenging. The six main communities in the Yolηu region of East Arnhem are, on average, 627 km from the nearest laboratory, making access to pathology results and follow-up of patients logistically challenging. The implementation of portable haemoglobin A1c point-of-care testing (POCT) in outreach, family-based services can reduce barriers related to transportation, waiting times and administrative procedures. This Short Communication reports on agreement analysis between a portable HbA1c POCT system and routine laboratory HbA1c testing in a very remote North East Arnhem Land community, Australia.