| Sumario: | We have identified and summarized 20 systematic reviews on the effects of various types of ambulatory services for patients with chronic diseases, defined as multidisciplinary care at a specialised level provided by a team at the patient's home or in the community, without admitting the patient admitted to hospital. Services can be provided from the hospital, from the municipality or in collaboration.1. Appropriately resourced early supported discharge (ESD) services provided for a selected group of stroke patients can reduce a combined outcome of death and dependency after 6 months, shorten the length of hospital stay and increase the possibility that the patient is independent and has taken up daily activities. There is probably no difference in mortality. ESD services may provide care at modestly lower total costs (versus usual care) for stroke patients with mild or moderate disability.2. For adults with acquired brain damage, heart failure, coronary heart disease, chronic obstructive pulmonary disease, multiple sclerosis, epilepsy and leg ulcer, and for children with various chronic diseases, ambulatory multidisciplinary services are likely to provide some improvements in health outcomes and quality of life, and increased satisfaction with treatment. Many of the studies, however, were small and of moderate methodological quality, so it was difficult to draw firm conclusions. Further research is likely to affect our confidence in the results, and may change the results.3. We need more research to increase the evidence about the effects of ambulatory multidisciplinary services to improve health care for patients with chronic diseases, and to reduce the use of specialist care services.
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