P06S04: Transient Ischemic Attack (replace
aspirin)
Bottom line: Information on Transient Ischemic
Attack (TIA) was used to justify the management of the patient (replace aspirin
by clopidrogel). It contributed to increase patient knowledge, avoid an
inappropriate treatment, and prevent health deterioration.
Level 1 outcome (situational relevance): On May 16,
2008, P06 did a search at work, by themselves, and after an encounter with a
patient. They retrieved two information hits about TIA. The reported search objectives
were: To address a clinical question, to share information with a patient and a
caregiver, and to plan, manage, coordinate, delegate or monitor tasks with
other health professionals. “My colleague
saw him [the patient] and said that he had a TIA. And she did not change [his
treatment]. She said "it is your patient, you do what you think is
best." Then I said "OK". I did not really know what to do. So I
pulled this out [the information]. [...] [The patient was a man] 81 years old
[...] I wanted to know if I should stop Aspirin or, at his age, if I should put
him on Plavix or not. [...] I shared the information with the family [the
patient and his wife] and I said "Here are our choices. You can choose to
do this or that. Ultimately, it is your choice. I recommend this, but it is you
who must decide. [...] I was not sure if I needed to continue Aspirin with
Plavix, or if I should stop the Aspirin.” According to P06, the information
from e-Therapeutics+ was in agreement with and equally relevant as the information
from another health professional (physician), from another electronic resource
(UpToDate), as well as from another paper-based resource (Canadian Practice Guidelines
for Stroke).
Level 2 outcome (cognitive impact): Two hits were associated with a report of positive cognitive
impact (see table). Regarding practice improvement, P06 stated: “Now, I have a better idea
of what to do. And
the other thing is that I am able to educate my patients and why we make this
change (regarding P06S03H01).”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT):
Therapeutics tab – TIA - Prevention of ischemic stroke - Highlight with
surrounding paragraph (P06S04H01).
2) e-Therapeutics+ (CIRT):
Therapeutics tab – TIA - Prevention of ischemic stroke - Table 1: Drugs used in
secondary prevention of stroke (P06S04H02).
Level 3 outcome
(information use): Information on TIA 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+). “I
stopped the Aspirin and I put him on Plavix. […] Justify, in the sense that I
am going to stop the ASA and I’m going to start the Plavix, so… […] I never had
to initiate this therapy before, so, for me, it was new. […] I started him on
that, and I referred him to the Stroke Prevention Clinic.”
Level 4 outcome (patient health): Regarding
patient health, P06 reported that the information contributed to increase
patient knowledge, avoid an inappropriate treatment, and prevent health
deterioration (probabilistic outcome). “I
removed his Aspirin, [which is inappropriate after TIA, and started Plavix]
preventing a stroke, hopefully. [Information was shared with the patient as
mentioned above - Int: Did the patient need to be persuaded to make a change in
this case?] No, because he got scared when he had his stroke.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information Manage patient care |
Practice improved Learned something Reminded something Motivated to learn Confirmed Reassured |
Justify choice Understand issue |
Prevent Avoid Patient knowledge |