Table 1.

Model of stepped care (adapted from Katon et al⁶)

Level	Status	Practitioner roles
1	Preventive services and diagnosis of subclinical disorders	GP provides screening, diagnosis, preventive services, and patient education and monitors outcome
2	Newly diagnosed disorder, relapse or exacerbation of chronic disorder	GP diagnoses, prescribes treatment, and recommends lifestyle changes. Case manager ensures continuing contact, monitors symptoms and side effects, provides self management support, and refers back to doctor if patient fails to progress. Specialist supervises caseload of case manager
3	Failure to progress in level 2 care	Specialist consults with patient and GP and recommends change in treatment or lifestyle; specialist may provide several visits, preferably within primary care
4	Failure to progress in level 3 care	Specialist takes over care for patients who are not making progress in level 3 or those with higher initial levels of complexity