Understanding Access to Primary Healthcare in Rural Communities: A Multilevel Model Approach

Adapted by the full article from our VP of Product, Kelsey Pyde.

Imagine living 300 km from the nearest hospital. When a sudden health emergency strikes, your only choice is an expensive, weather‑dependent journey to the city. For many rural Albertans, this scenario is all too real. In this post, we explore how a Multilevel Model of Health can illuminate the barriers to primary care in rural areas, and how solutions like Alethea’s eConsult platform play a crucial role in closing those gaps. 

The Multilevel Model of Health: A Quick Overview

The Multilevel Model of Health recognizes that access to, and outcomes from, primary healthcare (PHC) emerge from factors interacting across four levels (Beheshti et al., 2019):

• Individual: Personal health behaviours, financial means, health literacy, and transportation access.
  
• Community: Availability of local clinics, social support networks, and cultural attitudes toward medical care.
  
• Healthcare System: Provider availability, service delivery models, and integration of health technology.
  
• Policy: Government regulations, funding allocations, and targeted programs for underserved populations.
  

By examining each layer, we can craft interventions that address the root causes of rural healthcare disparities.

Key Barriers in Rural Alberta

According to Gizaw et al. (2022), rural populations experience primary barriers at each level of the multilevel framework:

1. Individual-Level Barriers

• Low health literacy and economic instability prevent many from seeking care.
  
• Limited transportation options make even routine visits challenging.
  

2. Community-Level Barriers

• Many rural towns lack adequate healthcare infrastructure, such as family practice clinics or community health centers.
  
• Cultural norms and social determinants further inhibit proactive care-seeking.
  

3. Healthcare System Barriers

• Physician shortages and outdated technology strain existing services (Beheshti et al., 2019; Legere et al., 2024).
  
• Inconsistent adoption of telehealth leaves gaps in specialist access.
  

4. Policy-Level Barriers

• Unequal funding prioritizes urban over rural needs (Government of Alberta, 2024).
  
• Short‑term programs fail to build sustainable, long‑term infrastructure (Legere et al., 2024).

How Alethea Bridges the Gap

Alethea’s asynchronous eConsult platform directly addresses Healthcare System and Community level barriers by enabling rural PCPs to connect with specialists across over 40 disciplines, without requiring patients to travel. To date, Alethea has facilitated over 46,000 eConsults, reducing unnecessary referrals by 70% and delivering specialist advice within 24 - 48 hours (Alethea Medical, 2025). Key benefits include:

• Remote Specialist Access: PCPs submit cases with images and test results; specialists reply with management plans, cutting weeks or months from traditional wait times.
  
• Workflow Integration: Asynchronous consults fit seamlessly into busy clinic days, no scheduling conflicts or disruptive phone calls.
  
• Scalable Telehealth: By leveraging existing devices and broadband, Alethea extends expert care to every corner of Alberta, regardless of population density.
  

Provincial Comparisons: Alberta vs. Ontario & New Brunswick

A comparison across provinces reveals distinctive patterns (Syed & Dekleva, 2025):

• Physician Shortages: Alberta and New Brunswick face more severe shortages than Ontario.
  
• Telehealth Access: Ontario leads in virtual‑care infrastructure; Alberta performs moderately, while New Brunswick lags.
  
• Government Funding: Ontario receives the highest per‑capita investment, followed by Alberta, then New Brunswick.
  

Despite initiatives like Alberta’s MAPS program, rural communities still experience significant service gaps. Alethea’s platform helps fill those gaps by delivering equitable specialist support, complementing policy‑level reforms with immediate, practice‑level solutions.

Strategies for Bridging the Gap

1. Community‑Based Programs

• Mobile clinics and school‑based health initiatives extend outreach (Gizaw et al., 2022).
  
• Student‑led partnerships can bolster service availability in underserved regions.
  

2. Telehealth & eConsults

• Virtual consultations overcome geographic barriers and reduce travel costs (Legere et al., 2024; Jong et al., 2018).
  
• Alethea’s eConsult network streamlines specialist input, empowering PCPs with rapid expert guidance.
  

3. Policy‑Level Interventions

• Primary Health Care Grants expand rural clinic capacity (Government of Alberta, 2024).
  
• Rural Medicine Programs train and retain providers in remote communities (University of Alberta, 2023; University of Calgary, 2023).

Improving PHC access in rural communities demands a multilevel strategy, empowering individuals, strengthening communities, modernizing healthcare delivery, and enacting robust policy. Technology‑driven platforms like Alethea’s eConsult service deliver immediate, scalable solutions that complement long‑term reforms. By working together at every level, we can ensure that living hundreds of kilometres from major centres no longer means being cut off from the care you need and deserve.

Read the full article by Kelsey Pyde, our VP of Product, here.

References

Alethea Medical. 2025. 2024 eConsult Statistics.
Beheshti, L., et al. 2019. “Telehealth in Primary Health Care: A Scoping Review.” Perspect Health Inf Manag.
Government of Alberta. 2024. Primary Health Care Grants Program Overview.
Gizaw, M., et al. 2022. “Barriers to Primary Health Care Access in Rural Ethiopia.” BMC Health Serv Res.
Jong, M., et al. 2018. “Telehealth Adoption in Northern Canada.” Can J Rural Med.
Legere, L., et al. 2024. “Evaluating Telehealth Impact on Rural Health Outcomes.” J Telemed Telecare.
Syed, F., & Dekleva, C. 2025. Comparative Analysis of Rural Healthcare Access in Canada.
University of Alberta. 2023. Rural Medicine Residency Program.
University of Calgary. 2023. Rural Health Professions Action Plan.