P02S06: Gout (colchicine)
Bottom line: Information on gout was used to modify the management of
the patient, and to persuade the patient to make changes (only short term
treatment with colchicine). There were no information-related patient health
outcomes.
Level 1 outcome (situational relevance): On April 4, 2008, P02 did a search at work, with a student, and during
an encounter with a patient. P02 searched outside of the examination room, and
went back in. They retrieved three information hits about gout. The reported search objectives were: to address a
clinical question, and to search in general or for curiosity. It was an elderly
man. [
] A patient who has problems with gout and he occasionally was using
colchicine, and he was having a flare up, and basically came in for likely pain
relief and treatment. [
] [I searched] about that particular patient, about the
management for him. [
] I
generally was looking at drug therapy. [
] Then again, just to learn for myself about the use
of colchicine and some of the treatments recommended. [
] We decided to look up gout and
then, I remember talking to a colleague, a physician because I dont think I
had seen or I treated really anyone with colchicine. According to P02, the
information from e-Therapeutics+ was in agreement with and equally relevant as
the information from another professional (physician colleague). I would say in general, it [the physicians information] would have been
in agreement, [
] [and] I would say equally [relevant]
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding practice
improvement, P02 stated: [My practice is
changed and improved in terms of] the different drug options and maybe
what you would choose first in terms of management, [
] just choosing the
better option for the patient. [
] Myself, I probably would have went more to
an NSAID rather than colchicine, more of an [anti]inflammatory therapy.
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT): Therapeutics tab key word: gout
Musculoskeletal
Disorders: Gout and Hyperuricemia table 4 (P02S06H01).
2) e-Therapeutics+ (CIRT): Therapeutics tab key word: gout
Musculoskeletal
Disorders: Gout and Hyperuricemia Pharmacologic choices (P02S06H02).
3) e-Therapeutics+ (CIRT): Therapeutics tab key word: gout
Musculoskeletal
Disorders: Gout and Hyperuricemia Therapeutic tips (P02S06H03).
Level 3 outcome
(information use): Information on gout was retrieved, and used to maintain (be more certain
about) the medication, to modify the management of the patient, and to persuade
the patient to make a change. The information has been modified to fit the
clinical circumstances (elderly man with gout and colchicine) as follows:
P02S06H03 tip Colchicine is not a good choice for treating acute gout was
adapted in accordance with the routines of the patient (colchicine user) and
suggested only for a short-term therapy. [We
used the information to modify the current management, i.e.,] how he
[the patient] was using the colchicine, the frequency. We were just going to
have him use it for a short blast during the acute part. [
] We may have to
have a discussion with the patient about the use of colchicine being that he
was elderly. And that, in the future, may not be the best option [suggesting
using NSAID instead of colchicines], about being careful with it. [
] He [the patient] was educated about the
treatment, and being, obviously, accepting of it, and also the recommendations
about use of it.
Level 4 outcome (patient health): There was no clear
relationship between the found information and expected patient health outcomes
(no follow-up yet).
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Satisfy curiosity |
Practice improved Learned something Reminded something Motivated to learn Confirmed |
Persuade Manage differently Be more certain |
No outcome |