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.