Key messages

- Specialist outreach clinics in primary care and rural hospital settings can improve access to care, quality of care, health outcomes, patient satisfaction and use of hospital services.
- Rural communities possibly have the most to gain from outreach, since specialist services are usually disproportionately concentrated in major urban areas.
- However, this review found only nine studies that evaluated the effects of outreach clinics compared to usual hospital-based care, using robust research designs. None of these was from low or middle-income countries.
- While there may be significant potential benefits, the quality of studies seriously limits the ability to draw conclusions about whether specialist care leads to improved health outcomes and, if so, at what cost in low and middle-income countries.
- In urban settings in high-income countries specialist outreach as part of more complex interventions improved health outcomes and the quality of care, and reduced the use of inpatient services.