Introduction: One critical component of any rural community is its healthcare system. Rural healthcare systems are essential as rural communities have worse health outcomes when compared to urban areas. Rural healthcare systems might also have a positive impact on rural economies. In some rural areas, these health services are threatened with a reduction or closure. This rapid review was carried out to examine the impact of rural healthcare systems' declines on rural economies. Methods: We conducted a rapid review of peer-reviewed and grey literature sources on studies that examined the economic impact of rural healthcare on rural economies in Canada, Australia, Scandinavia and the United States of America (USA). We used a data extraction template adapted from the Centre for Reviews and Dissemination. Results: We found 17 research papers between two databases and nine websites. Articles examined various health professions (dentist, physician assistant and pharmacist), the inclusion of family physicians, a physician with an increased scope of practice (obstetrics and surgery), the impact of a rural primary care hospital, telemedicine, a distributed medical education programme and the health care sector. Conclusion: Rural healthcare seems to have a positive impact on jobs and labour-based wages in rural communities. There is a considerable need for research outside the USA.

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Introduction: This study examines the state of Rural and Northern Physician Group Agreement (RNPGA) physician teams in rural Northern Ontario in terms of demographics, intent to stay, length of stay, number of physicians relative to the RNPGA-designated complement and perceptions of various workplace and community factors. Materials and Methods: Data were based on a survey mailed, in 2018, to Ontario physicians in RNPGA communities having a designated complement of 2 or more physicians. Physicians reported on aspects of the work environment, community and intentions to stay. Results: Sixty-five percent of all practices and 91.7% of those with a designated complement of 2 physicians were at or above their government-designated complement. Intent to stay was higher in groups below complement. The mean length of stay was 11.3 years. More physicians were male (58.7%). Older physicians were more represented in smaller practice groups. Physicians reported positive ratings on several aspects of their work environment, community and intentions to stay. Length of stay in the community was related to strong family ties and was a predictor of intent to stay. Many physicians had neither strong family ties (65.3%) nor a rural upbringing (57.3%). Conclusion: The results show positive outcomes in terms of: high intentions to stay, satisfaction with workplace and community factors, and full recruitment into RNPGA groups designated for a complement of two physicians. Further research is needed to understand the role of family ties to length of stay, and the role of level of physician complement and group size in retention and recruitment.

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Introduction: Obesity is an important public health concern, and large studies of rural–urban differences in prevalence of obesity are lacking. Our purpose is to compare body mass index (BMI) and obesity in Canada using an expanded definition of rurality. Methods: A cross-sectional analysis of self-reported BMI across diverse communities of Canadians aged 45–85 years was conducted using data from the Canadian Longitudinal Study on Aging (CLSA), a national sample representative of community-dwelling residents. Rurality was identified in the CLSA based on residential postal codes, which were divided into 4 categories: urban, peri-urban, mixed and rural. Logistic regression models were constructed to calculate adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) between obesity (BMI ≥30 kg/m² from self-reported weight and height) and rurality, adjusting for age, sex, province, marital status, number of residents in household and household income. Results: Twenty-one thousand one hundred and twenty-six Canadian residents aged 45–85 years, surveyed during 2010–2015, were included. 26.8% were obese. Obesity was less prevalent amongst urban (25.2%) than rural (30.3%, P < 0.0001), mixed (28.7%, P < 0.0001) or peri-urban communities (28.1%, P < 0.0001). When compared to urban areas, the aOR (95% CI) for obesity was 1.09 (1.00–1.20) in rural regions and 1.20 (1.08–1.35) in peri-urban settings. In areas of mixed urban and rural residence, the aOR was 1.12 (0.99–1.27). Conclusion: One in four Canadian adults were obese. Living in a non-urban setting is an independent risk factor for obesity. Rural–urban health disparities could underlie rural–urban differences, but further research is needed.

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Introduction: Wait times to see an orthopaedic consultant can be lengthy. Remote communities such as Labrador City and Goose Bay, located in Labrador in the province of Newfoundland and Labrador, often do not have an orthopaedic specialist locally and patients are required to travel great distances to attend clinic appointments. The objectives of this report are to describe our Orthopaedic Outreach Programme where patients receive fracture assessments and care for musculoskeletal concerns at two local clinics by a visiting orthopaedic surgeon. We also describe the justification for the Orthopaedic Outreach Programme and list the benefits; financial and otherwise. Methods: A review of the programme, operating out of Happy Valley-Goose Bay and Labrador City, using electronic medical records, was undertaken from 1^st January 2015 to 31^st December 2019 including demographics and procedures completed. Travel and hotel costs were estimated. Results: Over the last 5 years, the Orthopaedic Outreach Programme treated 1,698 patients at the 2 clinics. Cost savings were estimated at $366,768 per annum. The cost savings over the last 5 years were estimated at a total of $1,833,840. This does not account for patient's time off work and lost revenue that would occur when they make the trip to St John's for a clinic appointment. Conclusions: Our Orthopaedic Outreach Programme was implemented to improve access to orthopaedic services in the remote areas of Labrador. This report aims to describe the result of a programme focused on providing orthopaedic care to individuals who would otherwise be required to travel great distances for their care.

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