Specialist outreach clinics in primary care and rural hospital settings.

Abstract

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.

Evidence on bringing specialised care to the primary level—effects on the Quadruple Aim and cost-effectiveness: a systematic review

“…The same result was found in all six interviews/questionnaires in which the topic was addressed, strengthening the quantitative result. Bringing specialists to primary care also seemed to be advantageous for the patient in other ways: patient-reported experience measures and quantitative process outcomes improved in over 93% of the studies measured and in 67% of all studies included in this review, which is consistent with previous reviews [ 13 , 15 , 16 , 18 ]. Apart from the quantitative process outcome measures, reduced wait times were reported by the patient as an advantage in five of the six interviews.…”

Evidence on bringing specialised care to the primary level—effects on the Quadruple Aim and cost-effectiveness: a systematic review

“…The same result was found in all six interviews/questionnaires in which the topic was addressed, strengthening the quantitative result. Bringing specialists to primary care also seemed to be advantageous for the patient in other ways: patient-reported experience measures and quantitative process outcomes improved in over 93% of the studies measured and in 67% of all studies included in this review, which is consistent with previous reviews [ 13 , 15 , 16 , 18 ]. Apart from the quantitative process outcome measures, reduced wait times were reported by the patient as an advantage in five of the six interviews.…”

Changes in Diagnosis, Treatment, and Clinical Improvement Among Patients Receiving Telemedicine Consultations

“…These findings are consistent with previous research on changing diagnosis and treatment. 32,33 For example, in a study by Bijl et al, 34 the frequency of changes in diagnosis made by a group of specialists (primarily internal medicine, neurology, and dermatology) was, on average, 55% (95% CI: 49%-61%) compared to our finding of 48%. The consulting dermatology specialist in our study changed the referral di- agnosis 56% of the time, compared to 49% (95% CI: 36%-61%) in the study by Bijl et al 34 Also, in a study by Federman et al, 35 dermatologists almost universally diagnosed dermatologic pathology (93% correct) whereas primary care providers correctly diagnosed conditions only 52% of the time.…”

Sporadic heath camps for children: Are we reaching the unreached?

“…The Cochrane review also concluded that the benefits of simple outreach models in urban non-disadvantaged settings seem small. 8 In the state of Meghalaya, as per NFHS-4, the underweight status of under 5 children is 22.9% and 29.9% in urban and rural areas respectively, our observations at the 3 health camps detected 0.01%, 3.17% and 8.3% underweight in under fives, which are far below the state statistics. Also, complete primary immunisation coverage for children (BCG, measles, and 3 doses each of polio and DPT/pentavalent) in the camps are 98.5%, 100% and 77%, respectively, as opposed to the state statistics of 81.4% and 58.5% in urban and rural areas respectively.…”

Evidence on bringing specialised care to the primary level—effects on the Quadruple Aim and cost-effectiveness: a systematic review

“…The same result was found in all six interviews/questionnaires in which the topic was addressed, strengthening the quantitative result. Bringing specialists to primary care also seemed to be advantageous for the patient in other ways: patient-reported experience measures and quantitative process outcomes improved in over 93% of the studies measured and in 67% of all studies included in this review, which is consistent with previous reviews [ 13 , 15 , 16 , 18 ]. Apart from the quantitative process outcome measures, reduced wait times were reported by the patient as an advantage in five of the six interviews.…”

Changes in Diagnosis, Treatment, and Clinical Improvement Among Patients Receiving Telemedicine Consultations

“…These findings are consistent with previous research on changing diagnosis and treatment. 32,33 For example, in a study by Bijl et al, 34 the frequency of changes in diagnosis made by a group of specialists (primarily internal medicine, neurology, and dermatology) was, on average, 55% (95% CI: 49%-61%) compared to our finding of 48%. The consulting dermatology specialist in our study changed the referral di- agnosis 56% of the time, compared to 49% (95% CI: 36%-61%) in the study by Bijl et al 34 Also, in a study by Federman et al, 35 dermatologists almost universally diagnosed dermatologic pathology (93% correct) whereas primary care providers correctly diagnosed conditions only 52% of the time.…”

Sporadic heath camps for children: Are we reaching the unreached?

“…The Cochrane review also concluded that the benefits of simple outreach models in urban non-disadvantaged settings seem small. 8 In the state of Meghalaya, as per NFHS-4, the underweight status of under 5 children is 22.9% and 29.9% in urban and rural areas respectively, our observations at the 3 health camps detected 0.01%, 3.17% and 8.3% underweight in under fives, which are far below the state statistics. Also, complete primary immunisation coverage for children (BCG, measles, and 3 doses each of polio and DPT/pentavalent) in the camps are 98.5%, 100% and 77%, respectively, as opposed to the state statistics of 81.4% and 58.5% in urban and rural areas respectively.…”

Evidence on bringing specialised care to the primary level—effects on the Quadruple Aim and cost-effectiveness: a systematic review

“…The same result was found in all six interviews/questionnaires in which the topic was addressed, strengthening the quantitative result. Bringing specialists to primary care also seemed to be advantageous for the patient in other ways: patient-reported experience measures and quantitative process outcomes improved in over 93% of the studies measured and in 67% of all studies included in this review, which is consistent with previous reviews [ 13 , 15 , 16 , 18 ]. Apart from the quantitative process outcome measures, reduced wait times were reported by the patient as an advantage in five of the six interviews.…”

Changes in Diagnosis, Treatment, and Clinical Improvement Among Patients Receiving Telemedicine Consultations

“…These findings are consistent with previous research on changing diagnosis and treatment. 32,33 For example, in a study by Bijl et al, 34 the frequency of changes in diagnosis made by a group of specialists (primarily internal medicine, neurology, and dermatology) was, on average, 55% (95% CI: 49%-61%) compared to our finding of 48%. The consulting dermatology specialist in our study changed the referral di- agnosis 56% of the time, compared to 49% (95% CI: 36%-61%) in the study by Bijl et al 34 Also, in a study by Federman et al, 35 dermatologists almost universally diagnosed dermatologic pathology (93% correct) whereas primary care providers correctly diagnosed conditions only 52% of the time.…”

Sporadic heath camps for children: Are we reaching the unreached?

“…The Cochrane review also concluded that the benefits of simple outreach models in urban non-disadvantaged settings seem small. 8 In the state of Meghalaya, as per NFHS-4, the underweight status of under 5 children is 22.9% and 29.9% in urban and rural areas respectively, our observations at the 3 health camps detected 0.01%, 3.17% and 8.3% underweight in under fives, which are far below the state statistics. Also, complete primary immunisation coverage for children (BCG, measles, and 3 doses each of polio and DPT/pentavalent) in the camps are 98.5%, 100% and 77%, respectively, as opposed to the state statistics of 81.4% and 58.5% in urban and rural areas respectively.…”