P04S08: Hypothyroidism
Bottom line: Information on hypothyroidism was used to maintain the management of the patient (medication). There
were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On October 9, 2008, P04 did a search at work, by themselves, and
before an encounter with a patient. They retrieved one information hit about hypothyroidism. The reported search objective was to
address a clinical question. “[The
patient was] in his mid forties. […] This man presented with anemia. […] I had checked
his thyroid levels and his TSH [thyroid-stimulating hormone] came back high. And he wasn’t having any symptoms of hypothyroidism.
So I decided I needed to review the more uncommon presentations of
hypothyroidism. So I wanted to go back and just refresh on investigations and
presentations and what not. […] I actually called him to review the blood work
because it just didn’t fit the clinical picture. And then he came in and redid
the physical exam and discussed what this meant for him. Reviewed whether he
had any symptoms or not and started him on some medication. […] I guess the
clinical question would be: what are the presenting signs and symptoms of
hypothyroidism.” According to P04,
the information from e-Therapeutics+ was in agreement with and equally relevant
as the information from another paper-based resource (Toronto notes). “The information is basically the same. It just
complements one another.”
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 knew that I needed to start him on
medication. So, it just confirms that I needed to do that. […] It was
reassuring that I was on the right track. […] It’s just a review with
information that I’ve learned but I don’t always use.”
Retrieved information hit(s):
1) e-Therapeutics+ (CIRT): Therapeutics tab – hypothyroidism - whole section (P04S08H01).
Level 3 outcome
(information use): Information on hypothyroidism was retrieved, and used to better understand a specific issue with
respect to the management of the patient, and to maintain (be more certain
about) the management of the patient (information used as presented in
e-Therapeutics+). “I was going to do all the things that they recommended […]. I
used the information just to guide my next visit with him. So, like I said, it
was a good review that yes I had to check certain things on the physical exam
and that I did have him also check some thyroid antibodies to try to determine
the cause of the hypothyroidism. […] I started him on the medication [Levothyroxin]. […] I
knew I wanted to start him on medication. I wanted to make sure that there
weren’t any other causes; that the medication would work.”
Level 4 outcome (patient health): Without this information, P04’s management of the patient would have
been the same. There were no clear relationships between the use of
information and expected patient health outcomes.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question |
Reminded something Confirmed Reassured |
Be more certain Understand issue |
No outcome |