Effect of an evidence-based website on healthcare usage: an interrupted time-series study

BMJ Open. 2016 Nov 9;6(11):e013166. doi: 10.1136/bmjopen-2016-013166.


Objectives: Healthcare costs and usage are rising. Evidence-based online health information may reduce healthcare usage, but the evidence is scarce. The objective of this study was to determine whether the release of a nationwide evidence-based health website was associated with a reduction in healthcare usage.

Design: Interrupted time series analysis of observational primary care data of healthcare use in the Netherlands from 2009 to 2014.

Setting: General community primary care.

Population: 912 000 patients who visited their general practitioners 18.1 million times during the study period.

Intervention: In March 2012, an evidence-based health information website was launched by the Dutch College of General Practitioners. It was easily accessible and understandable using plain language. At the end of the study period, the website had 2.9 million unique page views per month.

Main outcomes measures: Primary outcome was the change in consultation rate (consultations/1000 patients/month) before and after the release of the website. Additionally, a reference group was created by including consultations about topics not being viewed at the website. Subgroup analyses were performed for type of consultations, sex, age and socioeconomic status.

Results: After launch of the website, the trend in consultation rate decreased with 1.620 consultations/1000 patients/month (p<0.001). This corresponds to a 12% decline in consultations 2 years after launch of the website. The trend in consultation rate of the reference group showed no change. The subgroup analyses showed a specific decline for consultations by phone and were significant for all other subgroups, except for the youngest age group.

Conclusions: Healthcare usage decreased by 12% after providing high-quality evidence-based online health information. These findings show that e-Health can be effective to improve self-management and reduce healthcare usage in times of increasing healthcare costs.

Keywords: PRIMARY CARE; PUBLIC HEALTH; eHealth; health care utilization; health communication; interrupted time series.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Evidence-Based Practice / standards*
  • Female
  • Health Promotion / methods
  • Humans
  • Internet / statistics & numerical data*
  • Interrupted Time Series Analysis
  • Male
  • Middle Aged
  • Netherlands
  • Primary Health Care / statistics & numerical data
  • Referral and Consultation / statistics & numerical data*
  • Referral and Consultation / trends*
  • Telemedicine / economics
  • Young Adult