BEST PRACTICE PORTAL BEST PRACTICE PORTAL project presentation to the Scientific Committee Ferri et al Lisbon, 16th July 2010

Best Practice definitions Role of the portal The treatment module The Harm Reduction: conceptualization of the module Questions to the ScC Contents

EU action plan EU Drugs Action Plan for …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 bench- marks 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 Role of the Portal

Evidence does not make decisions, people do Haynes RB BMJ 2002;324:1350 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 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 Best Practice definition

Build the information around the specific European context by using data on clients and treatments Interactivity with countries Accessed by policy makers Added value of a EMCDDA Best Practice 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 Role of the Portal

The treatment module The Treatment Module

Next steps: (short term) add GRADE Profile collection of new studies and assessment with GRADE … The Treatment 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 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 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. Harm Reduction: conceptualization of the module (1) Evidence for the effectiveness and cost–effectiveness of interventions to reduce alcohol-related harm. (WHO 2009).

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. Harm Reduction: conceptualization of the module

Questions to the Scientific Committee Provide feed-back on the contents (rounds of consultations, or specific questions to individual members) Are the information provided comprehensive? Do you know about systematic reviews or guidelines that should be included here? Are you aware about studies published or ongoing that should be kept into consideration? Would you be available for prompt reactions to questions that may arise during the process? Would you indicate other colleagues, institutions that you think should be consulted for some specific questions?