Supervised integrated screening of low-back pain patients by a neurologist. A randomized clinical trial

In a randomized, controlled design, the effect of psychiatric consultation intervention in medical outpatients with low-back pain (N = 104) was assessed for the patients' subjective well-being and satisfaction of general practitioners (GPs) in their cooperation with the neurologists. The goal of the intervention was an integrated approach towards the patients' symptoms and the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 104 patients were subdivided into an intervention group (N = 50) and a control group (N = 54). The major outcome measures were the psychological status of the patient and degree of the GPs' satisfaction concerning the cooperation with the medical specialists. After 6 months follow-up, there was a greater overall decline of symptoms in the patient intervention group compared with the control group. However, it was not possible to specify this effect. Contrary to the hypotheses, GPs in the control group were as satisfied about the cooperation with the neurologist as their colleagues in the intervention group. Yet, the information in the specialists' letters of the intervention group was more often in agreement with the integrated model carried out. It is concluded that great diversity of the target group of patients and the focus on the neurologists' behavior may explain the lack of hypothesized effects. It is recommended that the target group be more specifically defined, and that a more intensive intervention might prove to be more effective.