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Cited by 228Healthcare Systems and TechnologyPrimary Care and Health OutcomesHealth Services Management and Policy

Specialist outreach clinics in primary care and rural hospital settings

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Gruen, Russell L, Weeramanthri, Tarun S., Knight, Stephen S.E., Bailie, Ross S·2003·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd003798.pub2PMC PMC9016793
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Abstract

BACKGROUND: Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. OBJECTIVES: To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in "Specialist Outreach Clinics in General Practice" (Roland 1998), and the reference lists of all retrieved articles. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. DATA COLLECTION AND ANALYSIS: Four reviewers working in pairs independently extracted data and assessed study quality. MAIN RESULTS: 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple 'shifted outpatients' styles of specialist outreach were shown to improve access, but there was no evidence of impact on health outcomes. Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care, education or other services was associated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. The additional costs of outreach may be balanced by improved health outcomes. REVIEWER'S CONCLUSIONS: This review supports the hypothesis that specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention. The benefits of simple outreach models in urban non-disadvantaged settings seem small. There is a need for good comparative studies of outreach in rural and disadvantaged settings where outreach may confer most benefit to access and health outcomes.

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  1. Gruen RL, Bailie R. Evaluation of the Specialist Outreach Service in the Top End of the Northern Territory. (Menzies Occasional Papers). Darwin, Australia: Menzies School of Health Research, February 2000. [ISBN 0 9587722 3 1] [Google Scholar]
  2. Katterhagen JG, Howe HL, Lehnherr M. Effectiveness of an oncology outreach program. Journal of Oncology Management 1993;March/April:32‐37. [Google Scholar]
  3. Ferguson B. Psychiatric clinics in general practice: an asset for primary care. Health Trends 1987;19:22. [PubMed] [Google Scholar]
  4. Williams P, Strathdee G. The expanding concept of community psychiatric care: the British experience. New Trends in Experimental & Clinical Psychiatry 1985;2:217‐228. [Google Scholar]
  5. Almehdi R, Wisnewski A, Gallery R, Donnelly P. Surgical outreach in Queensland's far northwest: preliminary analysis of a new surgical service. Aust NZ J Surg 2001;71(5Suppl):RS20. [Google Scholar]
  6. Bruusgaard D. Specialists visiting rural general practices in Norway. Journal of the Royal College of General Practitioners ‐ Occasional Paper 1980;10:1‐2. [Google Scholar]
  7. Crosier J, Stoops N, Goldschmidt RB. Rural orthopaedic services in the Western Cape. South African Bone and Joint Surgery 1994;4(1):8‐10. [Google Scholar]
  8. Cybulska BA. AGUM meeting on Outreach Services in Genitourinary Medicine. Association of Genito‐Urinary Medicine. International Journal of STD & AIDS 1997;8(5):347‐350. [DOI] [PubMed] [Google Scholar]
  9. Little BC, Aylward GW, Gregson R, Wormald R, Courtney P. Community ophthalmology pilot study. Eye 1993;7(Pt 1):180‐183. [DOI] [PubMed] [Google Scholar]
  10. Loefler IJP. Visits to out‐lying hospitals. Proc Assoc Surg East Aftrica 1986;9:32‐36. [Google Scholar]
  11. Parish D. 'The eye mob comin': Eye health services to Aboriginal people in the Northern Territory 1982‐1998. Darwin: NT Aboriginal Eye Health Committee (NTAEHC), 1999. [Google Scholar]
  12. Perrett K. Sheffield.. In: Roland M, Shapiro J editor(s). Specialist outreach clinics in general practice. Abingdon: Radcliffe Medical Press, 1998:9‐15. [Google Scholar]
  13. Pullen IM, Yellowlees P. Scottish psychiatrists in primary care: a silent majority. Br J Psychiatry 1988;153:663‐666. [DOI] [PubMed] [Google Scholar]
  14. Wood AM. Surgery in East Africa: Communications. Proc Assoc Surg East Aftrica 1981;4:115‐120. [Google Scholar]
  15. Toupin A, Denford‐Nelson B. Arthritis Society outreach program: British Columbia and Yukon Division. Canadian Journal of Rehabilitation 1993;6(4):238‐243. [Google Scholar]
  16. Walshe K, Shapiro J. Wolverhampton.. In: Roland M, Shapiro J editor(s). Specialist outreach clinics in general practice. Abingdon: Radcliffe Medical Press, 1998:18‐35. [Google Scholar]
  17. Australian Medical Workforce Advisory Committee (AMWAC). Sustainable specialist services: a compendium of requirements. Report No. 1998.7.. Sydney: AMWAC, 1998. [Google Scholar]
  18. Bero LA, Grilli R, Grimshaw JM, Mowatt G, Oxman AD, Zwarenstein M. The Cochrane Effective Practice and Organization of Care Group (EPOC). The Cochrane Library. Oxford: Update Software, 2000. [Google Scholar]
  19. Golele R. Orthopaedic services in peripheral hospitals. South African Bone and Joint Surgery 1994;4(1):24‐26. [Google Scholar]
  20. London D. Reaching out is hard to do. Health Serv J 1995;11 May:15. [Google Scholar]
  21. Mitchell R. Psychiatric liaison in general practice. Update 1990;34:834‐841. [Google Scholar]
  22. Musk AW, Rhys‐Hearn C. Review of specialist medical services to rural and remote Aboriginal communities in Western Australia. Perth: University of Western Australia, 1996. [Google Scholar]
  23. Petchey R. Specialist Outreach Clinics in General Practice. BMJ 1998;316(7136):1028. [PubMed] [Google Scholar]
  24. Robb PJ. Otolaryngology in the GP fundholder practice. J Laryngol Otol 1995;109:95. [PubMed] [Google Scholar]
  25. Roland MO, Shapiro J (eds). Specialist outreach clinics in general practice. Abingdon: Radcliffe Medical Press, 1998. [Google Scholar]
  26. Sprod A. Outreach clinics. Br Dent J 2001;191(11):594. [DOI] [PubMed] [Google Scholar]
  27. Strathdee G, Williams P. A survey of psychiatrists in primary care: the silent growth of a new service. J R Coll Gen Pract 1984;34(268):615‐618. [PMC free article] [PubMed] [Google Scholar]
  28. Taylor HR. Eye health in Aboriginal and Torres Strait Islander Communities. Canberra: Commonwealth of Australia, 1997. [Google Scholar]

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Authors
Gruen, R. L., Weeramanthri, T. S., Knight, S. S. E., & Bailie, R. S.
Affiliations
  • The Royal Melbourne Hospital (AU)
  • Government of Western Australia Department of Health (AU)
  • University of KwaZulu-Natal (ZA)
  • Flinders University (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2003-10-20
Volume
2010
Issue
1
Pages
CD003798-CD003798
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd003798.pub2
PMC
PMC9016793
OpenAlex
W1893961784
Cited by
228
References
144
Citations by year
2026: 6 · 2025: 5 · 2024: 11 · 2023: 10 · 2022: 9 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 8 · 2017: 12 · 2016: 17 · 2015: 9 · 2014: 15 · 2013: 20 · 2012: 15
FWCI
0.64
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
  • ANU Open Research (Australian National University) (submittedVersion)
Topics
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
Keywords
primary care, rural hospitals, access to specialist care, primary-secondary care integration, multicomponent intervention, health outcomes, patient satisfaction, service utilization, health policy options, rural health care, health disparities
MeSH terms
Community-Institutional Relations, Health Services Accessibility, Hospitals, Rural, Humans, Medically Underserved Area, Medicine, Primary Health Care, Specialization, Randomized Controlled Trials as Topic, Rural Health Services

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