Background
Method
Search strategy
Criteria | Inclusion | Exclusion |
---|---|---|
Time period | 1990–2013 | Before 1990 |
Language | English | Other languages |
Geographical delimitation | High income economy (World Bank definition) | Low and Middle income countries |
Level of health care | Primary Healthcare (WHO definition) | Secondary, tertiary services |
Aim: to identify the impact or effectiveness of types of visiting services | • Paper must evaluate the impact or effectiveness (or both) of one or more visiting models | • Paper does not evaluate either impact or effectiveness |
Type of Information | Source | Strategy |
---|---|---|
Databases | • Ovid Medline • EBSCO CINAHL • Informit • Cochrane Library | (visiting OR outreach OR mobile OR “fly in fly out” OR fifo OR “drive in drive out” OR locum$ OR “hub and spoke”) AND (primary health care OR primary care) AND (rural OR remote) AND (evaluat$ OR efficien$ OR impact OR effective$) |
Grey Literature | • Healthinfonet (www.healthinfonet.ecu.edu.au) • National Rural Health Alliance (http://www.ruralhealth.org.au/) • Services for Australian Rural and Remote Allied Health (www.sarrah.org.au) • CRANAplus (https://crana.org.au/) • Health Systems Evidence (http://www.healthsystemsevidence.org) • Australia Institute of Health and Welfare (http://www.aihw.gov.au/) • Health Workforce Australia (http://www.health.gov.au/internet/main/publishing.nsf/Content/hwa-archived-publications) • Northern Territory Government Department of Health (http://www.health.nt.gov.au/) • Western Australian Government Department of Health (http://www.health.wa.gov.au/home/) • South Australian Government Department of Health (http://www.sahealth.sa.gov.au) • Tasmanian Government Department of Health and Human Services (http://www.dhhs.tas.gov.au/) • Victorian Government Department of Health (http://www.health.vic.gov.au/) • New South Wales Government Department of Health (http://www.health.nsw.gov.au) • Queensland Government Department of Health (http://www.health.qld.gov.au/) • Australian Government Department of Health (http://www.health.gov.au/) | The same search terms were used for these websites as was used for the databases. |
Methods of screening and selection criteria
Data extraction
Results
Study characteristics
Author/s and Year | How Located |
---|---|
Aljasir & Alghamdi (2010) [15] | EEDa |
Allen (1996) [12] | EED |
Jackson-Pulver (2010) [16] | EED |
McDermott et al. (2001) [17] | EED |
Roberts-Thomson et al. (2010) [19] | EED |
Rowley et al. (2008) [14] | EED |
Scrace & Margolis (2009) [18] | EED |
Author/s and Year | Type of Study | Outcomes Assessed | Key Findings |
---|---|---|---|
Aljasir & Alghamdi (2010) | Descriptive cross-sectional design | • Satisfaction with structure of visiting service • Satisfaction with services provided • Overall satisfaction compared with primary health care centres | • 35.8% rated the location of the clinic as unsatisfactory • 20.5% rated the schedule (1/week) as unsatisfactory • 62.5% indicated the mobile clinic provided a lower quality of service compared with a primary health care centre • 90.9% suggested that the mobile clinic was not dependable in providing health care in the area |
Allen (1996) | Case study | • Number of clients accessing the service • Reasons for accessing the service • Cost comparison between Outreach Service and Hospital Service | • 59 clients accessed physiotherapy appointments in the first 4 months • 30 clients attended for long-standing musculoskeletal pain syndromes, 29 attended for acute musculoskeletal pain/injuries • $7 to $10 for a hospital occasion of service (15 min direct client contact) compared with $36 for the outreach service |
Jackson-Pulver et al. (2010) | Retrospective cross-sectional audit of dental service client records | • Level of dental volunteer involvement, client attendance, and treatment provision • Perceptions of stakeholders regarding practical arrangements, care provided, and future directions | • The program met a pressing need (eliminated a 2 year waiting list) • Enhanced workforce development • Continuity of care was important to virtually all respondents • Cross-cultural relationships were fostered |
McDermott et al. (2001) | Unblinded Cluster RCT | • Weight, blood pressure, eye and foot care, serum lipid levels, glucose monitoring and control, urinary albumin to creatinine ratio, serum creatinine levels • Administration of recommended vaccines • Hospitalisation in previous 12 months | • A greater improvement in most measures over the 12 months in the intervention sites • At follow-up, those in the intervention groups were 40% less likely to be hospitalised for a diabetes-related condition than those in control group |
Roberts-Thomson et al. (2010) | Cluster RCT | • Oral health promotion activities in the community • Personal oral health practices of children | • No significant differences in the uptake of community level oral health promotion activities between the intervention and control communities at the two year follow-up • No significant difference on the clinical measures between children in the intervention and control groups |
Rowley et al. (2008) | Cohort study with population level data as a comparator | • Mortality from all causes and from cardiovascular disease • Hospitalisation with cardiovascular disease coded as a primary cause of admission | • Mortality significantly lower than that of the NT Indigenous population • Hospitalisation with CVD as a primary cause was 13/1000 person-years for the cohort, compared with 33/1000 person-years for the NT Indigenous population. |
Scrace & Margolis (2009) | Retrospective longitudinal report comparing historical controls with a dedicated fly-in/fly-out primary care skin cancer outreach clinic | • Skin cancer diagnosis and management | • An increase in the number of lesions removed per year • Four-fold increase in melanoma detection |
Data synthesis
Discussion
Key Principles | Papers | ||||||
---|---|---|---|---|---|---|---|
Aljasir & Alghamdi | Allen | Jackson-Pulver et al. | McDermott et al. | Roberts-Thomson et al. | Rowley et al. | Scrace & Margolis | |
Justification | Service established to improve equity and access | Described community consultations | Inability to attract a resident dentist | Not mentioned | Not mentioned | A “degree of unmet need for medical treatment”; mobile service enables population to stay on traditional homelands | Describes a known higher rate of skin cancer in remote areas |
Scheduling | Expressed dissatisfaction relating to service scheduling only once per week. | Not mentioned | Not mentioned although a Steering Committee was established | Not mentioned | Not mentioned | Mentions regular outreach visits “at the direction of the Health Council” | Mentions regularly scheduled visits but not how the schedules are derived |
Co-ordination | No resident service and no mention of other services | Describes the presence of existing health infrastructure as a major advantage | Not mentioned although a Steering Committee was established | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
Scope | No mention of scope but study participants dissatisfied with range of services | Physiotherapy, occupational therapy, and social work | Dental service | Diabetes outreach service | Oral health | Not mentioned | Skin cancer clinic |
Continuity | Not mentioned | Described as essential | Important to “virtually all respondents” & maintained in project design | Not mentioned | Not mentioned | Not mentioned | Mentions continuity of care as an ideal but not achieved in this study |
Support | No resident team | Not mentioned | Integration within a primary health care setting described as important | Mentions that this is likely to be important | Integrating oral health care into broader primary care activities described as important | Not mentioned | Describes harnessing local resource to promote the service |
Review | The study is an example of the type of review that should occur. No mention made of this occurring routinely. | Not mentioned | This study is an evaluation of the service but no mention made of this occurring routinely. | This study is an evaluation of the service but no mention made of this occurring routinely. | This study is an evaluation of the service but no mention made of this occurring routinely. | Follow up of previous population-based surveys | Not mentioned |