This Chapter outlined the results of a focussed literature review of specialist outreach services, and also of telemedicine approaches.

Overall, there have only been a few systematic reviews of outreach specialist services, and these have suffered from insufficient numbers of studies meeting the criteria for good quality intervention studies. Nevertheless, the conclusions have generally been positive in overall effectiveness and cost effectiveness. A key concern is that the opportunity costs of specialists being absent from their usual place of practice or those with alternative investments that could have been made have not been sufficiently explored. Alternative means of delivery have also been explored, including telemedicine and upskilling of primary care providers to provide some specialist care.

Apart from the systematic reviews, there have also been individual studies of specialist outreach, including that provided in remote Australian settings. The findings from these individual studies have also been generally positive. Examples of benefits from these models include improved access, reduced costs, early detection for chronic disease and skin cancer, and more effective management of chronic diseases.

The literature on telehealth also found significant benefits of the approach for patients and carers. However, the full impact of telehealth cannot be adequately assessed due to the lack of properly designed studies comparing the approach to conventional modes of service delivery, particularly in terms of cost effectiveness.