The effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: a pilot study

Drummond, Colin and Coulton, Simon and James, Darren and Godfrey, Christine and Parrott, Steve (2009) The effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: a pilot study. British Journal of Psychiatry, 195 (5). pp. 448-456. ISSN 0007-1250 . (Full text available)

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http://dx.doi.org/10.1192/bjp.bp.108.056697

Abstract

Background Screening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial. Aims To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care. Method A total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency. Results Both groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention. Conclusions Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.

Item Type: Article
Subjects: H Social Sciences > HV Social pathology. Social and public welfare > HV5001 Alcohol use and miuse
R Medicine > RA Public aspects of medicine
R Medicine > RT Nursing
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Tony Rees
Date Deposited: 23 Aug 2010 11:03
Last Modified: 15 May 2014 11:23
Resource URI: http://kar.kent.ac.uk/id/eprint/24382 (The current URI for this page, for reference purposes)
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