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Specialist outreach clinics in primary care and rural hospital settings
Open accessAbstract
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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“A similar approach has been employed in a previously conducted review of specialist outreach clinics in primary care and rural hospital settings that is published in The Cochrane Library (Gruen 2004).”
From Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes (2013) · cites this paper as Gruen 2004
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Metadata
- 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)
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Technology
- Health Sciences › Medicine › Family Practice › 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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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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