TY - JOUR
KW - Adult
KW - Alcohol-Related Disorders/diagnosis/economics/therapy
KW - Community Mental Health Services/economics/methods
KW - Cost-Benefit Analysis
KW - Epidemiologic Methods
KW - Health Care Costs/statistics & numerical data
KW - Humans
KW - Male
KW - Primary Health Care/economics/methods
KW - Quality of Life
KW - Treatment Outcome
KW - Wales
AU - C. Drummond
AU - S. Coulton
AU - D. James
AU - C. Godfrey
AU - S. Parrott
AU - J. Baxter
AU - D. Ford
AU - B. Lervy
AU - S. Rollnick
AU - I. Russell
AU - T. Peters
A1 - 
AB - 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.
BT - The British journal of psychiatry : the journal of mental science
C5 - Financing & Sustainability
CP - 5
CY - England
DO - 10.1192/bjp.bp.108.056697
IS - 5
JF - The British journal of psychiatry : the journal of mental science
N2 - 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.
PP - England
PY - 2009
SN - 1472-1465; 0007-1250
SP - 448
EP - 456
EP - 
T1 - Effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: Pilot study
T2 - The British journal of psychiatry : the journal of mental science
TI - Effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: Pilot study
U1 - Financing & Sustainability
U2 - 19880936
U3 - 10.1192/bjp.bp.108.056697
VL - 195
VO - 1472-1465; 0007-1250
Y1 - 2009
ER -