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The Rate and Variation of Referrals to Behavioral Medicine Services for Patients Reporting Poor Mental Health in the National Spine Network

Study Design. Descriptive analysis of cross-sectional data collected prospectively in 20 National Spine Network (NSN) centers. Objectives. First, to summarize clinical and demographic characteristics of patients likely to need servicesfor psychosocial concerns. Second, to determine the rate and variability of referrals for behavioral medicine interventions (BMED) across the NSN. Summary of Background Data. The prevalence of mental distress resulting from or coexisting with spinal pain is unclear. There is evidence that psychological treatments, particularly BMED, can aid the recovery of patients with symptoms of mental distress. Methods. From 1998 to 2001, 28,349 patients presenting to NSN centers completed the SF-36 General Health Survey. Patients were dichotomized by the mental component summary (MCS) score into two groups: 1) those scoring ≤35 on the MCS scale (patients self-reporting significant signs of mental distress) and 2) those scoring >35. Clinicians recorded a “treatment plan” comprised of a standard array of treatment options. For patients scoring ≤35 on the MCS, the rate and variation of referrals to BMED was assessed. Results. Baseline health status scores were lower across all SF-36 scales for the patients scoring an MCS ≤ 35. For mentally distressed patients, the overall average referral rate for any BMED service for patients scoring MCS ≤ 35 was 11.8%. The rate varied across NSN sites from 0 to 41%. Conclusion. With only 11.8% of mentally distressed NSN patients receiving a referral for any form of BMED, it appears that a large proportion of eligible patients are not receiving a potentially beneficial treatment. Wide variation across centers may indicate an inability to adequately assess mental distress via the usual clinical interview and examination for spinal conditions or a lack of consensus regarding BMED’s availability and utility.