SUPERVISED INTEGRATED SCREENING OF LOW-BACK-PAIN PATIENTS BY A NEUROLOGIST - A RANDOMIZED CLINICAL-TRIAL

In a randomized, controlled design, the effect of psychiatric consulta tion 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 neurologi sts. The goal of the intervention was an integrated approach towards t he patients' symptoms and the improvement of the cooperation between p rimary and secondary medical health services. The intervention was des igned at the health care provider level; the psychiatrist did not see or examine the patient. The 104 patients were subdivided into an inter vention group (N = 50) and a control group (N = 54). The major outcome measures were the psychological status of the patient and degree of t he GPs' satisfaction concerning the cooperation with the medical speci alists. After 6 months follow-up, there was a greater overall decline of symptoms in the patient intervention group compared with the contro l group. However, it was not possible to specify this effect. Contrary to the hypotheses, GPs in the control group were as satisfied about t he cooperation with the neurologist as their colleagues in the interve ntion group. Yet, the information in the specialists' letters of the i ntervention group was more often in agreement with the integrated mode l carried out. It is concluded that great diversity of the target grou p of patients and the focus on the neurologists' behavior may explain the lack of hypothesized effects. It is recommended that the target gr oup be move specifically defined, and that a more intensive interventi on might prove to be more effective. (C) 1996 Elsevier Science Inc.