Hormone replacement therapy and its association with LATE-NC in older adults.

Disparities in access to healthcare services and poorer health outcomes are long‐standing issues for rural and regional communities. Recent national reporting reinforces the persistence and scale of these disparities. The Australian Institute of Health and Welfare [] identified that approximately 7 million people, around 27% of the Australian population, live in rural, regional and remote areas, where inadequate access to healthcare services remains a long‐standing systemic issue. The report highlighted a clear gradient of worsening health outcomes with increasing remoteness, with rural and remote populations experiencing higher rates of chronic disease, injury and mortality, as well as lower utilisation of primary healthcare services compared with metropolitan residents. These entrenched inequities underscore the need for service models that can sustainably deliver accessible, integrated care in geographically dispersed communities. Despite initiatives to increase access to services that support improving health outcomes, disparities continue []. A multipurpose service (MPS) is a distinct model of health and aged care service delivery that brings together a variety of services under one management structure. This integrated approach enhances continuity of care and ensures more efficient use of limited resources [, ]. The MPS program was initiated over 25 years ago to address these issues by combining federal and state health funding to provide a health service that would meet the needs of rural communities, particularly where standalone aged care services were not viable [, ]. In Australia today (latest data—2025), there are 183 MPS in existence; 66 of these are located in regional or rural New South Wales []. It is timely to review the efficacy of this service model in meeting current and future health demands of regional and rural communities. Recently there have been two significant inquiries into healthcare systems within Australia that have focussed on people who live in regional and rural areas. Both inquiries were initiated in response to persistent and systemic inequities in rural health and aged care. Chronic workforce shortages, declining health outcomes with increasing remoteness and the ‘tyranny of distance’, which limits timely access to primary, acute and specialist services, have long affected rural communities. National data highlight higher rates of chronic disease, injury and mortality among rural residents, alongside reduced service utilisation. These entrenched challenges prompted governments to examine whether existing models, including the MPS model, were capable of delivering safe, sustainable and equitable care. In both inquiries, MPS were identified as a potential mechanism to address these challenges. The first of these two inquiries was the Royal Commission into Aged Care Quality and Safety []. In this report, the flexibility of the MPS model was recognised to address aged care service provision in communities. This model was seen as useful where standalone independent aged care providers might find the delivery of an aged care service a fiscal deterrent, or where aged care services were not being met even if there were existing aged care services within that local area. When aged care services are combined with acute care facilities, the opportunity to share the health workforce and other resources makes the MPS model an attractive economic option. This report also suggested that the MPS program should be expanded, and that governments should consider establishing MPS in areas where no acute care services exist []. This would require additional funding from governments to establish new facilities while also ensuring that existing MPS infrastructures are improved and updated to meet the current needs of local communities.