Article Text

This article has a correction. Please see:

Download PDFPDF

Effect of an evidence-based website on healthcare usage: an interrupted time-series study
  1. Wouter A Spoelman1,
  2. Tobias N Bonten1,
  3. Margot W M de Waal1,
  4. Ton Drenthen2,
  5. Ivo J M Smeele2,
  6. Markus M J Nielen3,
  7. Niels H Chavannes1
  1. 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Dutch College of General Practitioners, Utrecht, The Netherlands
  3. 3Department of Primary Care, NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
  1. Correspondence to Prof Dr Niels H Chavannes; n.h.chavannes{at}


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.

  • eHealth
  • health care utilization
  • interrupted time series
  • health communication

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Twitter Follow Tobias N. Bonten at @tbonten, Ton Drenthen at @Ton_Dr and Niels H Chavannes at @NHChavannes

  • Contributors WAS and TNB designed the study, analysed the data, interpreted the data and drafted the paper. MWMW and NHC designed the study, interpreted the data and revised the paper. TD and IJMS revised the paper. MMJM interpreted the data and revised the paper.

  • Funding The NHG and LUMC funded the analyses for this study. Funding was provided to the Netherlands Institute for Health Services to prepare and extract the data from their data set.

  • Competing interests TD and IJMS are employed by the Dutch College of General Practitioners, which financially supports the website

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Technical appendix, statistical code, and data set available from the last author (NHC).

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Miscellaneous
    British Medical Journal Publishing Group