P04S06: Psoriasis
Bottom line: Information on psoriasis was used to justify
the management of a patient (topical calcipotriol added to topical steroids),
and it contributed to prevent health deterioration and improve health.
Level 1 outcome (situational relevance): On May 30, 2008, P04 did a search at work, with a student, and during
an encounter with a patient. They retrieved two information hits about psoriasis. The reported search objectives were: to
address a clinical question, to fulfill an educational or research objective,
to look up something they forgot, to exchange information with other health
professionals, and to plan, manage, coordinate, delegate or monitor tasks with
other health professionals. “This was in regards
to a woman in her late 50s who has quite bad psoriasis and she had a bad
outbreak. […] She presented which some exacerbation of her psoriasis and I
believe there was a secondary cellulitis on top of it, on her hands. […] I was
wondering what the next step would be for her as a topical treatment for
psoriasis. I believe she was already on a topical steroid. I think she was on a
mid-potency corticosteroid. This wasn't working, so she needed something stronger.
[…] [I was] going over the treatment of psoriasis with my student. […] I had
used this medication long go, but hadn’t used it in recent history, I wasn’t
sure. […] [I wanted to exchange information and plan] with this student I was
working with.” According to P04, the information from e-Therapeutics+ was in
agreement with and more relevant than the information from another paper-based
resource (pharmacological book from nurse
practitioners). “I think it was just a table regarding […] steroids
in general, for topical treatment in general. […] It was probably less
relevant. I probably got more information from [e-Therapeutics+].”
Level 2 outcome (cognitive impact): Two hits were associated with a report of positive
cognitive impact (see table). Regarding practice improvement, P04 stated: “I'm more comfortable with Dovonex now. […] [My
practice will be changed and improved] just knowing what to prescribe as a
next-line treatment. […] The psoriasis exacerbation is something that I don't
see often.”
Retrieved information
hit(s):
1) e-Therapeutics+ (CIRT): Therapeutics
tab – psoriasis – Table 3: Topical Psoriasis Therapies – row on Dovonex (P04S06H01).
2) e-Therapeutics+ (CIRT): e-CPS tab –
Dovonex monograph (P04S06H02).
Level 3 outcome
(information use): Information on psoriasis was retrieved, and used to better
understand a specific issue with respect to the management of the patient, and to justify the management of the patient (information used as presented
in e-Therapeutics+). “As the non-pharmacological treatment, she was doing
all of those, and we just reviewed that, so that was the justification for
continuing on [this management]. […] I used it [calcipotriol] in addition to
the treatment. […] I don't have a whole lot of experience with psoriasis
that does not respond to first-line treatment [topical steroids].”
Level 4 outcome (patient health): Regarding patient health, P04 reported that the information
contributed to prevent health deterioration and improve health (probabilistic
outcome). “She
came back a couple of days later and she was doing much better. [The management
justified by the found information] avoided it [psoriasis] from getting
worse, from the presentation worsening and then needing to go up to an even
stronger treatment. […] When she came in [before the search], she couldn't even
move her hands. So it had a great impact on her ability to function.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Fulfill educational objective Look up something forgotten Exchange information Manage patient care |
Practice improved Learned something Reminded something Motivated to learn Confirmed Reassured |
Justify choice Understand issue |
Improve Prevent |