John Powell1. 1. Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
Abstract
OBJECTIVES: To determine the benefits of holding specialist outreach clinics in primary care settings by means of a systematic literature review of UK studies. METHODS: Systematic searches of electronic databases, hand searches of journals, and contact with experts. Application of inclusion criteria. Study findings summarised. RESULTS: Fifteen studies met the inclusion criteria. Surveys of general practitioners (GPs), specialists and patients identified the perceived advantages of outreach clinics of improving GP-specialist communication and improving patients' experience and access. Reported disadvantages concerned administrative costs, accommodation costs and inefficient use of specialists' time. Comparative studies showed that more patients expressed a preference for outreach clinics than for hospital-based clinics, and measures of patients' satisfaction and convenience generally were higher for outreach clinics. Studies did not show any consistent difference in health outcome between outreach and hospital-based clinics. Outreach clinics had higher direct costs to the health system than hospital-based clinics. CONCLUSIONS: Health care purchasers and providers must decide whether the advantages in terms of patients' experience of outreach clinics are worth the additional costs. They also need to consider issues of equity, which have not been addressed in research to date. Copyright The Royal Society of Medicine Press Ltd 2002.
OBJECTIVES: To determine the benefits of holding specialist outreach clinics in primary care settings by means of a systematic literature review of UK studies. METHODS: Systematic searches of electronic databases, hand searches of journals, and contact with experts. Application of inclusion criteria. Study findings summarised. RESULTS: Fifteen studies met the inclusion criteria. Surveys of general practitioners (GPs), specialists and patients identified the perceived advantages of outreach clinics of improving GP-specialist communication and improving patients' experience and access. Reported disadvantages concerned administrative costs, accommodation costs and inefficient use of specialists' time. Comparative studies showed that more patients expressed a preference for outreach clinics than for hospital-based clinics, and measures of patients' satisfaction and convenience generally were higher for outreach clinics. Studies did not show any consistent difference in health outcome between outreach and hospital-based clinics. Outreach clinics had higher direct costs to the health system than hospital-based clinics. CONCLUSIONS: Health care purchasers and providers must decide whether the advantages in terms of patients' experience of outreach clinics are worth the additional costs. They also need to consider issues of equity, which have not been addressed in research to date. Copyright The Royal Society of Medicine Press Ltd 2002.
Authors: Chris Salisbury; Alison Noble; Sue Horrocks; Zoe Crosby; Viv Harrison; Joanna Coast; David de Berker; Tim Peters Journal: BMJ Date: 2005-12-06