P04S07: Hypercholesterolemia
Bottom line: Information on hypercholesterolemia was used to justify the management of a patient (change medication to
lower cholesterol). There were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On October 17, 2008, P04 did a search at work, by themselves, and
before an encounter with a patient. They retrieved one information hit about dyslipidemia. The reported search objectives were: to
address a clinical question and to look up something they forgot. “[The
patient was a man] in his [late] thirties […] who has type II diabetes [and
hypercholesterolemia]. He is of Philippino descent. And he was started on a
statin recently. And he was having elevated CPK [Creatine Phosphokinase] values.
So, I had to take him off of his statin. And I was trying to figure out what
the best second line option would be for this man. […] I just wanted to rub my
head around […] This is all reviewed it. We usually start with statins [for
hypercholesterolemia]. It’s not often that we have to switch them up. So, it’s
information that I have come across in the past. I just wanted to review it.” According to P04, 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 confirmation,
reassurance, and reminder, P04 stated: “I’ve taken him off the medication [side
effect confirmed by the retrieved information] I don’t have anything other than
that. […] [I am reassured] that I’m on the right track for what to do next.”
Retrieved information hit(s):
1) e-Therapeutics+ (CIRT): Therapeutics tab – dyslipidemia – pharmacologic choices section – lipid
lowering agents (P04S07H01).
Level 3 outcome
(information use): Information on dyslipidemia was retrieved, and used to justify the management of the patient
(information used as presented in e-Therapeutics+). “We discussed his options. His CPK levels still
haven’t come down to baseline. So we just discussed the options that we were
going to wait until he went back to baseline and then we would look at putting
him on another agent. […] We were going to wait a couple of weeks and he was
going to recheck his blood [CPK] and we left it at that. And once he normalizes
we’ll start him on a new medication, most likely a cholesterol absorption
inhibitor. […] The whole point would be to help make a decision on what the
next medication would be. So, the information used [on different types of drugs
that lower cholesterol] will be helpful in deciding what medication to put him
on. […] I am confident that this is the right choice to take him off the
medication and put him on something else.”
Level 4 outcome (patient health): There was no
information-related patient health outcomes (no follow-up yet). The new
medication “has
not been implemented yet.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten |
Reminded something Confirmed Reassured |
Justify choice |
No outcome |