Specialist Outreach to Isolated and Disadvantaged Communities: A Population-Based Study

Gruen, Russell L., Bailie, Ross S., Wang, Zhiqiang, Heard, Sam and O'Rourke, Ian C. (2006) Specialist Outreach to Isolated and Disadvantaged Communities: A Population-Based Study. The Lancet, 368 9530: 130-138. doi:10.1016/S0140-6736(06)68812-0

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Author Gruen, Russell L.
Bailie, Ross S.
Wang, Zhiqiang
Heard, Sam
O'Rourke, Ian C.
Title Specialist Outreach to Isolated and Disadvantaged Communities: A Population-Based Study
Journal name The Lancet   Check publisher's open access policy
ISSN 0140-6736
Publication date 2006-07-01
Sub-type Article (original research)
DOI 10.1016/S0140-6736(06)68812-0
Open Access Status File (Author Post-print)
Volume 368
Issue 9530
Start page 130
End page 138
Total pages 9
Editor Horton, R.
Place of publication London, U.K.
Publisher The Lancet Publishing Group
Collection year 2006
Language eng
Subject 321200 Public Health and Health Services
321214 Health and Community Services
321207 Indigenous Health
321202 Epidemiology
321208 Primary Health Care
730300 Health and Support Services
730206 Aboriginal and Torres Strait Islander health
Abstract Background Visiting-specialist clinics (specialist outreach) have the potential to overcome some of the substantial access barriers faced by disadvantaged rural, remote, and Indigenous communities, but the effectiveness of outreach clinics has not been assessed outside urban and non-disadvantaged settings. We aimed to assess the effects of outreach clinics on access, referral patterns, and care outcomes in remote communities in Australia. Methods We undertook a population-based observational study of regular surgical, ophthalmological, gynaecological, and ear, nose, and throat outreach visits, compared with hospital clinics alone, on access, referral practices, and outcomes for the populations of three remote Indigenous communities in northern Australia for 11 years. We assessed all new non-emergency potential specialist surgical cases who presented initially between Jan 1, 1990, and Jan 1, 2001. The effects of outreach clinics on the proportion of patients referred, the time from referral to initial specialist consultation, and the rates of community-based and hospital-based procedures were analysed using logic regression and Cox proportional hazard models. Findings 2339 new surgical problems presented in 2368 people between 1990 and 2001. Outreach improved the rate of referral completion (adjusted hazard ratio 1.41, 95% CI 1.07-1.86) and the risk of timely completion according to the urgency of referral (adjusted relative risk 1.30, 1.05-1.53). Outreach had no significant effect on initiation of elective referrals, but there were 156 opportunistic presentations on outreach clinic days. Specialist investigations and procedures in community clinics removed the need for many patients to travel to hospital, and outreach consultations were associated with a reduced rate of procedures that needed hospital admission (adjusted hazard ratio 0.67, 0.43-.03). Interpretation Specialist outreach visits to remote disadvantaged Indigenous communities in Australia improve access to specialist consultations and procedures without increasing elective referrals or demands for hospital inpatient services.
Keyword health services needs and demand
rural health services
indigenous health
outreach program
general -practitioners
Q-Index Code C1
Additional Notes This is an author version of an article originally published as R. Gruen, R. Bailie, Z. Wang, S. Heard, I. O'Rourke (2006) Specialist outreach to isolated and disadvantaged communities: a population-based study. The Lancet, 368 (9530) 8-14 July : 130-138. doi:10.1016/S0140-6736(06)68812-0 Copyright 2006 Elsevier. All rights reserved. Single copies only may be downloaded and printed for a user's personal research and study.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2007 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 32 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 35 times in Scopus Article | Citations
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Created: Tue, 01 Aug 2006, 10:00:00 EST by Zhiqiang Wang on behalf of School of Medicine