Transcript best practice portal

BEST PRACTICE PORTAL project
presentation to the Scientific Committee
Lisbon, 16th July 2010
Ferri et al
Contents
Best Practice definitions
Role of the portal
The treatment module
The Harm Reduction: conceptualization of the module
Questions to the ScC
Role of the Portal
EU action plan EU Drugs Action Plan for 2009-2012
…enhance the quality and effectiveness of drug demand reduction
activities(…)
Action 17
To develop, implement and exchange good practice guidelines/quality
standards for prevention, treatment, harm reduction and rehabilitation
interventions and services
Action 19
To develop an EU consensus on minimum quality standards and benchmarks for prevention, treatment,harm reduction and rehabilitation
interventions and services taking into account needs of specific groups
and the work done at national and international level
Best Practice definition
Evidence does not make decisions, people do
Haynes RB BMJ 2002;324:1350
From “evidences” to best practice
evidences
Carer
Patient
preferences
Costs and
Resources
expertise
Treatment
provision in the
context
Best Practice definition
Best Practice: a provisional definition
There is no universally accepted definition of a "best
practice." However, (…), a "best practice" is a practice that upon
rigorous evaluation, demonstrates success, has had an impact,
and can be replicated (Knowledge for health. Johns Hopkins Bloomberg School of
Public Health)
Best Practices are innovative, make a difference, have a
sustainable effect, have the potential for replication (serves as a
model for generating policies and initiatives elsewhere) (UNESCO
Management of Social Transformations (MOST) Programme)
Best Practice definition
Best Practice: a provisional definition
http://www.businessdictionary.com/definition/best-practice.html
Best Practices:
Methods and technique that have consistently shown results
superior than those achieved with other means, and which are
used as benchmarks to strive for.
There is, however, no practice that is best for everyone or in
every situation, and no best practice remains best for very long as
people keep on finding better ways of doing things.
Best Practice definition
Best Practice: provisional definition
Practice of best available evidence
Added value of a EMCDDA Best Practice Portal
• Build the information around the specific European
context by using data on clients and treatments
• Interactivity with countries
• Accessed by policy makers
Role of the Portal
Structure of the information
• Simplicity is the ultimate sophistication.
• Perfection is attained, not when no more can be added, but when no
more can be removed
• Persons are the starting point and the ultimate
destination of the process
• Interventions are not “effective” per se’:
• they are effective in affecting some outcomes
• in some patients/clients
• under certain circumstances
Role of the Portal
Key points
• Question ⇨EU strategy documents
• Population ⇨ EPI data
• Interventions ⇨ Treatment Profile
• Outcomes ⇨ GL and Systematic Reviews
• Study designs ⇨ GRADE logic
The Treatment Module
The treatment module
The Treatment Module
Next steps:
(short term) add GRADE Profile
collection of new studies
and assessment with GRADE
…
Harm Reduction: conceptualization of the module
Population ⇨ clients (mainly) by route of administration
• Injecting drug users
• opioid injectors
• stimulant injectors
• Other routes of administration
• Prisoners
Harm Reduction: conceptualization of the module
Interventions ⇨ HR monograph
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Needle Syringe Programs (NSPs)
Opioid Substitution treatment (OST)
Community based outreach interventions
Peer Naloxone Distribution
Information, Education and Communication
Voluntary Counselling and Testing
Harm Reduction: conceptualization of the module
Outcomes (Risks) ⇨ HR monograph
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Reduction of Incidence of HIV, HCV, STI
Reduction of mortality
Reduction of morbidity
Criminality
Nuisance
Harm Reduction: conceptualization of the module
Study designs ⇨ GRADE logic
Systematic Reviews
RCTs
Cohort studies
Observational studies
Ecological studies
Harm Reduction: conceptualization of the module
Scoring of interventions (1) ⇨
Convincing – results from systematic reviews
or consistent evidence across many,
methodologically assessed, studies. These
interventions are very likely to obtain the
desired effects in different contexts.
(1) Evidence for the effectiveness and cost–effectiveness of interventions to reduce alcohol-related harm.
(WHO 2009).
Harm Reduction: conceptualization of the module
Scoring of interventions ⇨
Probable – results from a small number of,
methodologically assessed, studies or from a
number of weaker study designs. Results
from conflicting studies, provided the conflicts
are easily explained. These interventions are
effective in principle but some considerations
about their applicability under different
contexts need to be addressed before
implementation.
Harm Reduction: conceptualization of the module
Scoring of interventions ⇨
Limited suggestive – recommendation
generated from weaker studies and experts
opinions about the probable effect of an
intervention in presence of evident ethical or
feasibility limitations to perform an
appropriate study design. These interventions
should be considered with cautions due to the
risk of unintended effects.
Harm Reduction: conceptualization of the module
Scoring of interventions ⇨
Unknown effects – not enough studies to
assess an intervention. These interventions
need to be studied to assess the effects.
Questions to the Scientific Committee
Provide feed-back on the contents (rounds of consultations, or
specific questions to individual members)
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Are the information provided comprehensive? Do you know
about systematic reviews or guidelines that should be
included here?
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Are you aware about studies published or ongoing that
should be kept into consideration?
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Would you be available for prompt reactions to questions
that may arise during the process?
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Would you indicate other colleagues, institutions that you
think should be consulted for some specific questions?