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Aim: COVID‐19 rapidly transformed how Australians access health care services. This paper considers how the inability for urban patients to access in‐person care expediated the introduction of virtual solutions in health service delivery thus creating a new access paradigm for rural and remote Australians. Context: 'Physical distancing' is a phrase synonymous with public health responses to COVID‐19 in Australia, but distance is a decades‐long problem for rural health access. Counterintuitively, the pandemic and associated restrictions on mobility have reduced in real terms the distance from, and therefore the time taken to access, critical public services. 'Lockdowns' have unlocked health access for rural and remote Australians in ways that had been rejected prior to 2020. The pandemic has disrupted traditional delivery models and allowed the piloting of novel solutions, at the same time as stress‐testing current delivery systems. In the process, it has laid bare a myopia we term 'urban paternalism' in understanding and delivering rural health. Approach: This commentary outlines how the COVID‐19 operating environment has challenged traditional urban‐dominated policy thinking about virtual health care delivery and how greater availability of telehealth appointments goes some way to reducing the health access gap for rural and remote Australians. Conclusion: Australian Commonwealth Government policy changes to expand the Medical Benefit Scheme (MBS) to include telephone or online health consultations are a positive initiative towards supporting Australians through the ongoing public health crisis and have also created access parity for some rural and remote patients. Although initially announced as a temporary COVID‐19 measure in March 2020, telehealth has now become a permanent feature of the Medicare landscape. This significant public health reform has paved the way for a more flexible and inclusive universal health care system but, more importantly, taken much needed steps towards improving access to primary health care for patients in rural and remote areas. Now the question is: Can the health care system integrate this virtual model of delivery into 'business as usual' to ensure the long‐term sustainability of telehealth services to rural and remote Australia? [ABSTRACT FROM AUTHOR]

Background: Visiting services address the problem of workforce deficit and access to effective primary health care services in isolated remote and rural locations. Little is known about their impact or effectiveness and thereby the extent to which they are helping to reduce the disparity in access and health outcomes between people living in remote areas compared with people living in urban regions of Australia. The objective of this study was to answer the question "What is the impact or effectiveness when different types of primary health care services visit, rather than reside in, rural and remote communities?"Method: We conducted a systematic review of peer-reviewed literature from established databases. We also searched relevant websites for 'grey' literature and contacted several key informants to identify other relevant reference material. All papers were reviewed by at least two assessors according to agreed inclusion and exclusion criteria.Results: Initially, 345 papers were identified and, from this selection, 17 papers were considered relevant for inclusion. Following full paper review, another ten papers were excluded leaving seven papers that provided some information about the impact or effectiveness of visiting services. The papers varied with regard to study design (ranging from cluster randomised controlled trials to a case study), research quality, and the strength of their conclusions. In relation to effectiveness or impact, results were mixed. There was a lack of consistent data regarding the features or characteristics of visiting services that enhance their effectiveness or impact. Almost invariably the evaluations assessed the service provided but only two papers mentioned any aspect of the visiting features within which service provision occurred such as who did the visiting and how often they visited.Conclusions: There is currently an inadequate evidence base from which to make decisions about the effectiveness of visiting services or how visiting services should be structured in order to achieve better health outcomes for people living in remote and rural areas. Given this knowledge gap, we suggest that more rigorous evaluation of visiting services in meeting community health needs is required, and that evaluation should be guided by a number of salient principles. [ABSTRACT FROM AUTHOR]

Background: Access to rural health services is compromised in many countries including Australia due to workforce shortages. The issues that consequently impact on equity of access and sustainability of rural and remote health services are complex.Discussion: The purpose of this paper is to describe a number of approaches from the literature that could form the basis of a more integrated approach to health workforce and rural health service enhancement that can be supported by policy. A case study is used to demonstrate how such an approach could work. Disjointed health services are common in rural areas due to the 'tyranny of distance.' Recruitment and retention of health professionals in rural areas and access to and sustainability of rural health services is therefore compromised. Strategies to address these issues tend to have a narrow focus. An integrated approach is needed to enhance rural workforce and health services; one that develops, acknowledges and accounts for social capital and social relations within the rural community. [ABSTRACT FROM AUTHOR]

Objective: Colorectal cancer has geographic inequities in Australia, with higher mortality rates and lower participation in the National Bowel Cancer Screening Program (NBCSP) in remote and rural areas. The at‐home kit is temperature‐sensitive, necessitating a 'hot zone policy' (HZP); kits are not sent when an area's average monthly temperature is above 30°C. Australians in HZP areas are susceptible to potential screening disruptions but may benefit from well‐timed interventions to improve participation. This study describes the demographics of HZP areas and estimates the impacts of potential screening changes. Methods: The number of individuals in HZP areas was estimated, as well as correlations with remoteness, socio‐economic and Indigenous status. The potential impacts of screening changes were estimated. Results: Over a million eligible Australians live in HZP areas, which are more likely to be remote/rural, have lower socio‐economic status and higher Indigenous populations. Predictive modelling estimates that any 3‐month screening disruption would increase CRC mortality rates up to 4.1 times more in HZP areas vs unaffected areas, while targeted intervention could decrease mortality rates 3.4 times more in HZP areas. Conclusion: People living in affected areas would be negatively impacted by any NBCSP disruption, compounding existing inequities. However, well‐timed health promotion could have a stronger impact. [ABSTRACT FROM AUTHOR]