We conducted a focussed rather than a systematic review of the literature. PubMed was searched in August 2011 using the terms ‘outreach’ AND ‘specialist’. This yielded 202 articles. Following a review of abstracts, 30 articles were identified for further examination. We excluded articles that were not concerned with outreach services into rural communities. We examined the bibliography of the main systematic review of outreach services (Gruen, Weeramanthri, et al. 2004), and also a more recent ‘evidence report’ from Canada (Canadian Health Services Research Foundation 2008).

Other systematic reviews examined include a review of UK literature of the benefits of holding specialist clinics in primary care setting (Powell 2002), a review of the effectiveness of shared care across the interface between primary and specialty care in chronic disease management (Smith et al. 2007, 2008) and a review of interventions to improve outpatient referrals from primary care to secondary care (Akbari et al. 2008). The Smith et al. review explicitly excluded models based on outreach clinics. However, we have included the results of the review below as the issues examined are important in outreach settings. The Akbari review did not specifically study the impact of outreach clinics to improve referrals.

In addition to the papers analysed by Gruen, Weeramanthri, et al. (2004), we considered that some other more recent papers provided insights into the issues for outreach services. We were also referred to several papers by people interviewed through the project. Finally we also briefly reviewed literature on telemedicine approaches. A summary of findings is presented below.