P01S04: Sexual dysfunction
Bottom line: Information on sexual dysfunction induced by Selective Serotonin Reuptake Inhibitor (SSRI) was used to justify the management
of the patient, and persuade the patient to make a change (replace medication).
There were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On June 13, 2008, P01 did a search at work, with a nurse practitioner student, and during an
encounter with a patient. They retrieved one information hit about sexual
dysfunction induced by Selective Serotonin Reuptake Inhibitor (SSRI). The reported search objectives were: to address a clinical question,
to share the information with a patient, and to exchange information with other
health professionals. It was a man and he had depression and he was on an antidepressant, and
I think he had been on a couple of them, I'm not completely sure, but they all
caused him sexual dysfunction. He couldn't get an erection, so we were trying
to find something for his depression that would not result in impotence. [...] I was just trying
to figure out which drug was more appropriate for people who had sexual
dysfunction from most antidepressants.[
] So I could ask the patient do you
want to try this? And, I could share that with him and he could say yes and
no. [
] I had the nurse [practitioner student] with me, and that way, if I give
her the information, it's something that she can learn from it. [
] I basically
looked at the adverse effects column [
] for almost all of them it says sexual
dysfunction [
] except for the one that I chose [Wellbutrin]. According to P01,
e-Therapeutics+ was the only source for information, and the found information
was relevant.
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding practice improvement, P01 stated: Now that I know that there are alternatives I can make
suggestions for patients so that they don't have to suffer with sexual
dysfunction when they're on an antidepressant and I know now what I can switch
them to, if they want to try something different.
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT): Therapeutic tab depression - table 2 extract on sexual dysfunction (P01S04H01).
Level 3 outcome
(information use): Information on SSRI-induced sexual dysfunction was retrieved for a
patient, and used to justify the management of the patient and to persuade the
patient and other health professionals to make a change (information used as
presented in e-Therapeutics+). We gave him Wellbutrin [
]. I just started them [the patient]
on the initial dose that was listed there, and then I advised them to come back
so that we could pump it up a little bit to the regular maintenance dose. [
]
He was on another antidepressant. I think it was either Celexa or Cipralex or
something like that. So we modified his treatment. [
] I had to persuade him by
saying I know, you should go back and see Dr. Blank [pseudonym]. I know, I'm
not your regular provider but do you want to try this [Wellbutrin], see how it
goes, and then you can come back and see me or see Dr. Blank and we can see how
things are going? [...] I guess that there's always a chance that the
doctor might just say no no no, let's not try that one, keep going with
Cipralex and it's the better one for you. [
] And sometimes patients are very
adamant that they dont want any suggestions from other providers except their
own doctor.
Level 4 outcome (patient health): The
information-related patient health outcomes were unknown (no follow-up). He
did not come back, so I do not know how well it worked.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information Exchange information |
Practice improved Learned something Motivated to learn Reassured |
Persuade Justify choice |
No outcome |