Since the Gruen et al. (2004) review, there have been several descriptive studies of outreach services in Australia which are described below.
Broadbent & McKenzie (2006) describe a visiting palliative medicine specialist outreach service for Wagga Wagga in New South Wales. The service involved a visiting doctor flown from Sydney each fortnight for a day and integrated with the local nursing based palliative care team. During the first year of the service, the majority of referral to the specialists were for advice on cancer pain control (62.3%) and other symptoms (26.7%). Over 75% of patients referred had a palliative care issue that was considered appropriate for direct patient contact by the specialist in palliative medicine.
Whitehead (2006) describes the development of a geriatric outreach service providing geriatric assessment. The outreach service included a specialist geriatrician and an extended practice nurse specialising in aged care. In 18 months up to December 2004, 115 people were assessed by the extended practice nurse. Interventions relating to falls and cognition were provided to assessed clients. The model was assessed by comparing time from referral to seeing a specialist for the outreach clinic and metropolitan clinics. Time from referral to seeing a specialist was comparable across the settings. Health care providers referring patients to the clinic were surveyed. Responses indicated that the providers found the outreach service useful.
Carson (2009) provides a case study description of the organisation of surgical services in the Northern Territory. Historical approaches to addressing barriers of distance include a network of local health clinics, regional hospitals, and specialist surgical facilities, together with aeromedical services for patient and medical team transport. More recent initiatives have included an Aboriginal and Torres Strait Islander languages interpreter service, dedicated Indigenous health educators, and specialist outreach visits. Specialist services in the Northern Territory are delivered locally by appropriately trained generalists in cooperation with and supported by specialists from larger centres. Carson argues this model of delivery maximizes population access for a range of surgical therapies and encourages the efficient use of both specialists and generalists.
Cord-Udy (2003; 2004, 2006) describes the development of outreach psychiatry services under MSOAP in South Australia. Through the program there has been an expansion of visiting psychiatric services to rural and remote communities with important improvements for child and Aboriginal health services. It is argued the experience indicates that visiting psychiatric services can be sustainable and culturally appropriate for the benefit of Aboriginal people who live in one of the remotest places in Australia. The outreach work was also considered professionally rewarding for clinicians.
Tibby and colleagues (Tibby & Corpus 2008; Tibby et al. 2010) describe a model for providing outreach cardiac specialist services to Aboriginal and Torres Strait Islander communities in Queensland. The development of the service involve a stepped process starting with community engagement, moving to a delivery of recovery intervention, followed by building community capacity in terms of chronic illness self-management health promotion and ultimately to community self-governance of chronic disease and health promotion. Under the model specialist cardiac services and point of care diagnostics have been provided to 18 sites across Queensland. Around 1,400 episodes of care have been provided to Aboriginal and Torres Strait Islander Australians with rheumatic heart disease, ischaemic heart disease and congenital heart conditions.
Jones et al. (2011) provide a comprehensive and critical history of policy setting and implementation in relation to Aboriginal and Torres Strait Islander eye health services in Australia. The history describes many of the original outreach eye health services (e.g. those supported through the 1995 National Trachoma and Eye Health program the development of an outreach service for Cape York in the 1990s - Brian 1997). However, the reports focus is on the development and evolution of government policies. Some of the specific matters covered include:
- The establishment of VOS in 1995.
- The development of the National Trachoma and Eye Health program in 1976 funded by the Commonwealth Government and administered by the Royal College of Ophthalmologists.
- The national review of Indigenous eye health in 1997 (Taylor 1997) which led to the National Aboriginal Eye Health program. This included the initiatives to strengthen the integration of eye health into primary care services and in particular the funding of designated regional eye health coordinator positions across Australia based in community controlled health services.
- The origins and early history of a number of outreach services, including the establishment of MSOAP in 2000.