Effects of psychiatric consultation on medical consumption in medical outpatients with low back pain

A randomized, controlled, clinical trial ( N = 104) was conducted to test the hypothesis that a protocol of collaboration and communication between neurologist and general practitioner, sustained with psychiatric consultation, would reduce medical consumption (especially of diagnostic procedures and medication) in medical outpatients with low back pain. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. A reduction in medical consumption could not be demonstrated. As there was a great variation in adherence to the protocol in the experimental group, this might explain the lack of hypothesized effects. Full implementation of the protocol seemed to imply a lower number of major surgery operations, but this effect disappeared after excluding cases with a diagnosed hernia. The possibilities for consumption reduction for three post hoc-defined patient categories (cases with hernia and chronic and nonchronic cases) and the consequences for patient selection and treatment intensity are discussed. It is concluded that the target groups should be more narrowly defined, and that a more intensive intervention might prove to be more effective.