Organisation and delivery of care: Stepped care

TopicStepped care
Review question(s)5.4. In adults with alcohol misuse, what is the clinical efficacy, cost-effectiveness, and safety of, and patient satisfaction associated with different systems for the organisation of care?
Subquestion(s)
Chapter5. Assessment and delivery
Subsection5.8 Stepped care
Topic groupOrganisation of care/settings:
Colin Drummond
Steve Pilling
Laura Shields
Subsection leadColin Drummond
ObjectivesTo assess the effectiveness and benefits and harms of using a stepped care approach in organising and delivering care to those with harmful alcohol abuse or alcohol dependence
Criteria for considering studies for the review
 • InterventionStepped care
 • ComparatorTreatment as usual or control
 • Types of participantsAdults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week). Studies were excluded if the stepped-care approach was primarily aimed at addressing substance misuse (and therefore not alcohol focused), or if outcomes were not separated by substance type, or if participants did not consume at least 30 to 50 units of alcohol per week (to meet cut-offs for harmful or dependent alcohol consumption)
 • Critical outcomesDrinking frequency measures (for example, number of days drinking in the past month)
Drinking quantity measures (for example, DDD)
Relapse
Lapse
Abstinence
 • Important but not critical outcomes
 • Other outcomes
 • Study designRCTs were included in the narrative review in the first instance. As RCT evidence was limited, observational studies were included in the narrative review as well
 • Include unpublished data?Unpublished data was not included
 • Restriction by date?n/a
 • Dosagen/a
 • Minimum sample sizeTen per arm in the trial
 • Study settingOutpatient
Search strategyDatabases: COCHRANE, CINAHL, EMBASE, MEDLINE, PsycINFO

New search:
Searching other resources
17.

Reference searching – reference list of all retrieved articles and any previous reviews were sifted for additional trials which met inclusion criteria

18.

Personal contact – no authors were contacted or asked for their knowledge of other studies

19.

No drug companies were contacted for requests for additional data

Existing reviews
 • Updatedn/a
 • Not updatedn/a
General search filter used
Question specific search filter
Amendments to filter/search strategy
The review strategyNarrative review of RCTs and observational studies that could not be put into a meta-analysis
Additional assessmentsNo sensitivity analyses were conducted due to the limited number of studies included in the evidence review

From: Appendix 8, Review protocols

Cover of Alcohol-Use Disorders
Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence.
NICE Clinical Guidelines, No. 115.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2011.
Copyright © 2011, The British Psychological Society & The Royal College of Psychiatrists.

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