Co-located specialty care within primary care practice settings: A systematic review and meta-analysis

Background: Co-location of specialists in primary care has been suggested as an approach to reduce care fragmentation, inefficiency, and cost. We conducted a systematic review and meta-analysis evaluating the impact of co-located specialty care models in primary care settings. Methods: Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus was conducted through February 2015. A manual search of the included studies’ bibliographies was conducted. Randomized controlled trials (RCTs) and observational studies reporting physically co-located specialties in primary care on the following outcomes were included: patient satisfaction; provider satisfaction; health care access and utilization; clinical outcomes, and costs. Results: Of 1620 articles, 22 studies met inclusion criteria, including 9 RCTs and 13 observational studies. Co-located care was observed to be associated with increased patient satisfaction (OR 2.04; 95% CI 1.04–3.98), primary care provider satisfaction (OR 6.49, 95% CI 4.28–9.85), and outpatient visits (OR 1.94; 95% CI 1.13–3.33). Co-located care was associated with reduced appointment wait time (OR 0.20, 95%CI 0.10 – 0.41). Reduced costs and improvement in quality of life and selected diabetes related outcomes were also observed. Evidence quality was limited by few studies, high risk of bias, and heterogeneity. Conclusions: Co-located specialty care in primary care settings may support the aims of high value care delivery. However, additional studies are needed to further evaluate the value of co-location of specific specialties and stronger data on impact to health outcomes and cost.