P06S03:
Sexually transmitted infection (genital warts)
Bottom line: Information on the treatment of
sexually transmitted infection was used to maintain the management of the
patient (referral to a gynecologist). There were no information-related patient
health outcomes.
Level 1 outcome (situational relevance): On May 23,
2008, P06 did a search at work on two occasions: with a patient (during the
encounter), and by themselves (after the encounter with the patient). They
retrieved two information hits about sexually transmitted infection. The
reported search objectives were: To address a clinical question and to look up
something they forgot. “This was a young
(22 years old) woman who came with genital warts. Then I wanted to know,
besides cryotherapy, just to educate her, because I was referring her to a
gynecologist, just to prepare her for the [gynecologist] in terms of what
treatments are available. [...] I said: OK, let's see what else could be the
treatment, but the treatment [itself] will be given by the gynecologist. [...]
[After the patient encounter] I went back to the highlight on this
(lymphogranuloma venerium) LGV, because I've never seen that before. [...] I
wanted to know if maybe it could be a differential diagnosis. It was
interesting to me and I did not know what it was. [...] [So] I was looking for
the treatment with Aldara, to know what it was, how often the patients needed
to use it. [...] It is something that I have used in the past, but not
something you use every day, so it's in the drawer, and you need to look it up.”
According to P06, the information from e-Therapeutics+ was in agreement with
and equally relevant as the information from another electronic resource
(UpToDate), and was also in agreement with but less relevant than the
information from another paper-based resource (Clinical guidelines for family practice). “Here [in the Guideline], there was more information in relation to
“provide or administer treatment”. [...] It was in agreement [with
e-Therapeutics +], but there was more. ”
Level 2 outcome (cognitive impact): Two hits were associated with a report of positive cognitive
impact (see table). Regarding practice improvement, P06 stated: “I learned about
lymphogranuloma venerium, the LGV. It increased my knowledge. [...] It added a
differential diagnosis in my head that I need to think about. I must not think
just of genital warts, and this and that. I must not forget that there are
other things. The treatment is different (regarding P06S03H01).”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT):
Therapeutics tab – Genital warts - Sexually transmitted infection – Sexually
transmitted diseases - Highlight (P06S03H01).
2) e-Therapeutics+ (CIRT):
Therapeutics tab – Genital warts - Sexually transmitted infection – Sexually
transmitted diseases - Table 10 - extract on Aldara (P06S03H02).
Level 3 outcome
(information use): Information on sexually transmitted
infection 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, i.e., referral
to a specialist (information used as presented in e-Therapeutics+). “I had to send her to the gynecologist. [...]
Originally, I thought of giving her Aldara, but after that, reading what I
read, I said "no, but it will not be enough," and I cannot put it
inside. It has to be on the outside. [...] Since then, the gynecologist sent me
a letter saying that she had to use the laser [treatment] (regarding P06S03H02).”
Level 4 outcome (patient health): Without this
information, P06’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 Look up something forgotten |
Practice improved Learned something Motivated to learn Confirmed Reassured |
Be more certain Understand issue |
No outcome |