Evaluating a multispecialty e-consultation service between general practitioners and hospital specialists in the Netherlands.

Ken Peeters, Dennis Muris, Jochen Cals

Keywords: e-consultation, electronic consultation

Background:

E-consultations are asynchronous communication between GPs and specialists, potentially reducing hospital referrals and helping manage healthcare costs. While well-studied in North America, research in Europe is limited. Given universal healthcare systems and the GP’s gatekeeper role in many European countries, understanding e-consultation in this context is crucial for optimizing its integration and effectiveness.

Research questions:

What is the effect of using e-consultations between general practitioners and specialists on hospital referrals?

Method:

We analyzed e-consultations and referrals by GPs in a southern Netherlands region to the 10 largest hospital departments (2016–2023). Using interrupted time series analysis, we compared referral rates before and after e-consultation introduction, with national data as a reference. Patients with e-consultations were tracked in hospital EHRs for 6 months to determine if these consultations led to hospital referrals.

Results:

During the EGPRN meeting, we can present data from the ITS analysis for the 10 largest hospital departments between 2016 and 2023.* We will show the change in referral rate after introduction of e-consultation, for both the regional and national group.

EHR data shows that 30.2% of e-consultations result in a hospital referral. Non-surgical departments show a higher number of e-consultations, and a smaller proportion of these e-consultations leading to a referral.

*: we are waiting on national data. We expect to receive this soon, so we will be able to present full results and conclusion(s) at the EGPRN meeting.

Conclusions:

Results suggest the potential of e-consultations to reduce healthcare pressure. We used long-term follow-up data from a large number of healthcare consultations. The question remains whether the number of e-consultations is sufficient to impact hospital referral rates and whether this is a regional or national trend. Further research is needed to determine what proportion of e-consultations leads to avoided or additional referrals, and to explore differences in the suitability of e-consultations across specialties.

Points for discussion:

Are e-consultations already being used in your country, and do you think the findings from the Netherlands are generalizable to other countries in Europe?

Do you think e-consultations are suitable for all specialties and types of questions, or are there specific specialties or types of questions where e-consultations are more appropriate?

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