The best solution to needle exchange programs

Coverage of diabetic supplies varies by medical and pharmacy plan.

The best solution to needle exchange programs

At a minimum, there must be a sufficient number of higher-quality i. Rationale For well-designed interventions with well-designed experimental assessment procedures, examining each outcome one at a time is obviously justifiable on statistical and logical grounds.

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However, in light of the fact that most studies that have attempted to assess the effectiveness of needle exchange programs have limited study designs and that there are serious practical constraints associated with conducting a randomized control trial, some may conclude that it is impossible to ever determine whether needle exchange programs are effective.

Indeed, to adopt the position that evidence short of a randomized trial is useless amounts to denying the possibility of learning from experience—which, though often difficult, is not impossible. In many areas of social sciences and public health research, the so-called definitive study—a randomized control experiment that is, a randomized double-blind placebo controlled trial —is an ideal that cannot be implemented.

For example, it is unethical to consider use of a clinical trial design to show that smoking causes lung cancer Hill, Scientific judgment develops instead through a series of studies using cross-sectional retrospective and prospective designs, in which later research avoids the flaws of earlier work but may introduce problems of its own.

The improbability of being able to carry out the definitive study of the effects of certain HIV and AIDS prevention programs, including needle exchange programs, does not necessarily preclude the possibility of making confident scientific judgments about the effects of such prevention programs.

All scientific work is incomplete—whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time.

Sooner or later there comes a time for decision on the basis of evidence in hand. In the case of the efficacy of needle exchange programs, urgency is added because the disease in question—AIDS—is fatal, is contagious, and has been seen to spread rapidly in various settings.

The Role of Sterile Needles and Bleach. The National Academies Press. The panel therefore elected to rely on an approach that assesses the pattern of evidence in determining the effects of these HIV and AIDS prevention programs rather than relying on a preponderance of evidence approach.

In this approach to assessing the effects of needle exchange programs and the credibility of evidence surrounding a needle exchange program, we look at the consistency of the pattern of evidence that is available from multiple data sources about the same program.

Taking this approach greatly expands the depth and breadth of the evidentiary base, because we try to understand the relationships among the parts of the intervention model, the process, and their outcomes. Rather than interpreting the effects of the intervention on individual outcomes, in isolation, the pattern of evidence approach considers interrelated conditions, such as intermediate outcomes Cordray, For example, consider the evaluation of a needle exchange program that reveals a reduction in new HIV infections over time among injection drug users who used the program.

The best solution to needle exchange programs

By traditional standards, this design would be classified as relatively weak because there is no control or comparison condition. Without further information, it is not possible to confidently conclude that the introduction of the needle exchange program is responsible for the observed decline on the basis of this one piece of evidence the observed decline alone.

Ruling In Plausibility By examining whether certain required conditions were present, it is possible to probe the plausibility that the needle exchange program was responsible, at least in part, for the reduction.

This type of assessment requires the specification of a series of if-then propositions. That is, if there is a real connection between the introduction of the needle exchange program and the observed decline in new infections, then a series of conditions must be present in order to increase confidence in the conclusion that the program is at least partially responsible for the observed outcome.

The best solution to needle exchange programs

The conclusion that the needle exchange program is plausibly connected to the decrease in new HIV infections is more credible if there is evidence that, as the putative causal agent, it was actually present in the community. This means that there must be an empirical pattern of evidence that, in effect, rules in its plausibility.

Programmatically, the pattern of evidence might include: The argument that undergirds this approach is that programs have a structure and mechanisms that establish a logical pattern of expectations that can be tested empirically.

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To the extent that the empirical evidence supports these propositions, the plausibility that the needle exchange program was responsible for the observed change should increase.Number: (Includes CPB ) Policy. Note: Except for Medicare plans and where coverage is mandated by state law, generally coverage for diabetic supplies would be provided under a pharmacy rider and not as part of medical metin2sell.comn diabetic supplies may also be covered under the medical plan if no pharmacy or diabetic supplies rider is available.

In many jurisdictions, persons who inject drugs can access sterile needles and syringes through syringe services programs (SSPs) and through pharmacies without a prescription.

Though less common, access to sterile needles and syringes may also be possible through a prescription written by a doctor and through other health care services. Browse the WebMD Questions and Answers A-Z library for insights and advice for better health.

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Needle and syringe programmes (NSPs) for HIV prevention | AVERT