# Evaluation of an interdisciplinary electronic consultation service between general practitioners and medical specialists in The Netherlands: a prospective cohort study

## TL;DR

A study in the Netherlands found that electronic consultations between general practitioners and specialists helped reduce unnecessary hospital referrals while addressing a wide range of clinical questions.

## Contribution

This study provides novel evidence on the use and effectiveness of e-consultations in a Dutch healthcare system with gatekeeping general practitioners.

## Key findings

- E-consultations were used across all hospital departments, with most questions related to diagnosis and treatment.
- Approximately 36.8% of consultations led to avoided referrals, with the highest rate in Urology at 49.0%.
- Surgical departments saw more requests for general advice compared to other departments.

## Abstract

General practitioners (GPs) frequently encounter complex cases that require specialist input. Traditionally, this support is sought via telephone consultations, which are often constrained by time and availability, or through initiating a hospital referral. Interdisciplinary electronic consultations enable timely specialist advice while possibly reducing unnecessary referrals. Though prior research has shown promising outcomes for e-consultations, evidence remains limited, particularly from healthcare systems where GPs act as gatekeepers, such as in The Netherlands. It is also unclear whether similar benefits apply across other hospital departments.

This study aimed to evaluate how GPs in a Dutch healthcare setting used e-consultations across multiple hospital departments, focusing on both the content of the consultations and their impact on referral decisions.

We analyzed 2183 e-consultations submitted to Zuyderland Medical Centre between 2019 and 2022, with at least 24 months of data collected per department. Consultations were categorized by topic, and referral outcomes were assessed—specifically avoided versus additional referrals prompted by the e-consult.

E-consultations were used across all departments and addressed a wide range of clinical questions, most commonly related to diagnosis, diagnostic testing, and pharmacological treatment. In surgical departments, questions more often concerned general advice. Overall, 36.8% were avoided, while 11.9% additional referrals followed the e-consult. Avoided referral rates ranged from 32.6% in Pediatrics to 49.0% in Urology.

E-consultations support GPs in managing clinical uncertainty and may reduce unnecessary referrals, particularly when tailored to departmental contexts.