Effect of a multi-specialty e-consultation service on hospital referrals: an interrupted time-series study in the Netherlands.

Background
E-consultation services between family physicians and hospital specialists may help manage rising healthcare costs and improve care accessibility. Yet, robust evaluations of e-consultation impact on hospital referral patterns remain scarce.

Objective
To evaluate the effect of a multi-specialty e-consultation service between family physicians and medical specialists on hospital referral rates.

Design
An interrupted time series analysis was conducted in the Netherlands between 2015 and 2023, including family practices that submitted e-consultations to 11 specialties at a regional hospital.

Participants
Family practices from a specific region in the Netherlands that used the e-consultation service were included as the exposed group, and a national sample of family practices from the Nivel Primary Care Database served as the control group.

Intervention
Implementation of a multi-specialty e-consultation service.

Main Measures
Monthly referral rates for outpatient clinic visits were analyzed utilizing seasonal autoregressive integrated moving average (SARIMA) models and difference-in-differences analyses to evaluate trends before and after the introduction of the e-consultation service. Sensitivity analyses were performed using various lag periods, and subgroup analyses were conducted based on e-consultation volumes and family physician experience.

Key Results
There was a limited overall impact of e-consultations on hospital referral trends. Internal Medicine showed a regional reduction in referrals (−1.56% per month, p < 0.01), though this was not significant compared to national trends (difference-in-difference: 0.68%, p = 0.24). Surgery and Neurology showed significant regional increases (Surgery: + 1.76% per month, p < 0.01; Neurology: + 1.75% per month, p = 0.01), which were also significant compared to national trends in the difference-in-difference analysis (Surgery: −1.73%, p < 0.01; Neurology: −1.81%, p = 0.01). Subgroup and sensitivity analyses did not reveal consistent patterns or delayed effects.

Conclusions
Specialties did not show a clinically meaningful reduction in referrals, likely due to the relatively small proportion of e-consultations compared to regular referrals. While the overall effect was limited, targeted implementation of e-consultations within specific contexts may help optimize referral practices. Further research is needed to explore the contextual factors that influence the effectiveness of e-consultations.