Study designs of evaluations included in the review
All forms of study design were considered eligible, ranging from randomised controlled trials (RCTs) to surveys of professional opinion. However, studies of opinion were only included if they were based on professionals drawn from eight or more different purchasing or providing bodies.
Specific interventions included in the review
The authors were mainly interested in community-based adult hearing aid (audiology) services. However, due to the lack of studies specific to this topic, studies relating to community clinics in medical (including surgical) specialties were also considered. The inclusion criteria for medical-based studies were the provision of out-patient services at community locations, excluding non-UK studies. In the case of audiology, broader criteria were used, which included papers concerned with hearing aid use and after care, screening for hearing loss, counselling and the views of general practitioners (GPs). Community-based service was defined as a form of out-patient clinic or session that was provided by hospital staff (or equivalent) in a setting away from the main hospital base, other than the patient's own home. Studies were included when a patient or professional opinion was being canvassed in relation to community-based services, real or hypothetical. The findings of studies relating to medical and surgical specialties were only included when the reviewers were reasonably convinced that it was appropriate to generalise them to clinics providing hearing aid services (e.g. if there was consistent results across a wide variety of specialties).
Participants included in the review
The participants were adults attending community clinics. Studies of community-based antenatal clinics were excluded because of the very specific nature of the patient group and the variety of forms that the clinics took. However, studies in paediatrics were included on the basis that the clinics were attended by adults along with children and were of the same form as out-patient clinics in other specialties.
Outcomes assessed in the review
The outcomes of interest included: the extent and nature of community provision; patient access and satisfaction; professional opinion; clinical effectiveness and efficacy; impact on referrals and hospital work; cost; the primary-secondary care interface; and equity issues. Studies were excluded if no relevant objective evidence was presented.
How were decisions on the relevance of primary studies made?
One reviewer went through the titles resulting from the search and excluded all those that were obviously inappropriate. The reduced list, together with abstracts where available, were examined by each of the four team members independently, who classified each title as not relevant, possibly relevant, or probably relevant - obtain paper. The authors did not state how the eligibility of the retrieved studies was assessed, or how many reviewers were involved in this process.