P04S01: Dyslipidemia
Bottom line: Information on dyslipidemia (lipid-lowering agents) was used to maintain
the management of a patient, and to persuade a physician to make a change (from
adding a new medication to maintaining current medication). It contributed to avoid unnecessary treatment and blood
tests.
Level 1 outcome (situational relevance): On July 16, 2008, P04 did a search at work, by themselves, and during
an encounter with a patient. P04 searched outside the examination room, and
went back with information. “My computer
is in a separate room.” They retrieved two information hits about
dyslipidemia. The reported search objectives were: to address a clinical
question, to look up something they forgot, to share information with a patient
or caregiver, to exchange information with other health professionals, and to plan,
manage, coordinate, delegate or monitor tasks with other health professionals. “[The patient was] in his early 50s.
[…] He was a patient of the physicians, but my nurse practitioner student was
seeing him and he was already on cholesterol medication but wasn't at his
target so we were trying to find out whether it was appropriate to start him on
another medication, or to leave it for a specialist to do, because he also had
some high liver enzymes, which complicated the picture. […] So the clinical
question would be how to manage his dyslipidemia; […] which medication would be
most beneficial? […] [We wanted] to discuss his options, so he could be a
partner in making the decision about what medication to use, or treatment. […]
[I also wanted] to discuss the management plan with the physicians and the
student nurse practitioner, […] and just going over the most relevant
information we could find, the most up-to-date information.” According to P04, the information from e-Therapeutics+ was in
agreement with and more relevant than the information from another paper-based
resource (drug pamphlet). “It [the pamphlet] was less relevant. […] It was just focused on how much
(percentage) the cholesterol could be decreased. It was just very specific
regarding that aspect of it.”
Level 2 outcome (cognitive impact): Two hits were associated with a report of positive cognitive impact (see table). Regarding motivation, confirmation, reassurance, and reminder, P04 stated: “There is always something new coming up that I
didn't know about before, so I'm always motivated to [learn more] recheck, keep
looking. […] It [the information] just confirmed my hypothesis that we didn't
really need to add that medication right now, that there were some risks at
doing it that outweigh the benefits. […] It wasn't new information; I just
needed to review the specifics regarding the treatment.”
Retrieved information hit(s):
1) e-Therapeutics+ (CIRT): Therapeutics tab – Dyslipidemia – Table 4: Lipid-lowering Agents-Effect
on lipoproteins (P04S01H01).
2) e-Therapeutics+ (CIRT): Therapeutics tab – Dyslipidemia – Table 6: Lipid-lowering Agents
(P04S01H02).
Level 3 outcome
(information use): Information on dyslipidemia was retrieved, and used to better understand
a specific issue with respect to the management of the patient, to maintain (be
more certain about) the management of the patient, and to persuade another
health professional to make a change (information used as presented in
e-Therapeutics+). “We ended up not changing any of his medication at that point in time.
[…] And because the physician had wanted to put him on this certain type of
medication, by reading e-Therapeutics, we decided that it probably wasn’t the best
course of action. […]
We [physician, student, P04] also decided to refer him to a lipid clinic for
further treatment.”
Level 4 outcome (patient health): Regarding patient
health, P04 reported that the information contributed to avoiding unnecessary
treatment and blood tests. “The potential of putting them [the patient] on the
medication could have increased his liver enzymes to the point where we would be
worried about it, so that was to […] prevent having to test it more frequently, and watch
him carefully.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten Share information Exchange information Manage patient care |
Reminded something Motivated to learn Confirmed Reassured |
Persuade Be more certain Understand issue |
Avoid |