P06S07:
Diabetes mellitus
Bottom line: Information on diabetes mellitus
was used to justify the management of the patient (continue medication). It
contributed to avoid an unnecessary intervention and prevent health
deterioration.
Level 1 outcome (situational relevance): On November 7,
2008, P06 did a search at work, by themselves, and after an encounter with a
patient. They retrieved one information hit about diabetes mellitus. The
reported search objectives were: To address a clinical question, to look up
something they forgot, to share information with a patient, and to plan,
manage, coordinate, delegate or monitor tasks with other health professionals.
“[It was] a young man who was recently
diagnosed with diabetes, in the beginning of the year. Then suddenly, in
October, his creatinine began to rise, for an unknown reason. [...] [The
patient was] a man, around 36-37 years old, [...] and I wanted to check ...
Because Glucophage and metformin, it can affect it may cause 'lactic acidosis'
if it builds up, so I wanted to know what the cut-off was to stop taking the
Glucophage (metformin). [...] That's what I forgot. [...] [I wanted] to be able
to explain why we should change his medication. [...] He was transferred to the
Department of Nephrology, then [...] adjustments to medication had to be made
by the residents and the nephrologist.”According to P06, the information
from e-Therapeutics+ was in agreement with and less relevant than the
information from another health professional (physician), and from another
paper-based resource (Diabetes
Association Guidelines). “[What the
doctor told me,] it was more relevant, in the sense that he gave me
suggestions, "if he reaches this level, it might be necessary to change
this medication", so there were steps to follow. [...] [And the Guideline
also] was more relevant, because it gave me other options. His creatinine is
rising and we should try this medication.”
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive
impact (see table). Regarding confirmation, reassurance, and reminder, P06 stated: “[I was reassured] I wasn’t going to kill my
patient by giving him metformin. […]I knew that there were limits, but I did
not remember what they were.”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT): e-CPS tab –
Glucophage – contraindication section (P06S07H01).
Level 3 outcome
(information use): Information on diabetes mellitus 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 had my answer that I
did not need to stop the medication. [...] I reassessed his laboratory results and they were still within the 'safe range'
(compared to values provided by eCPS), so I did not really change
anything in terms of his medication. [...] His levels are stable (of creatinine
and creatinine clearance), so we did not change. [...][The information was
used] to justify that I can keep him on the metformin.”
Level 4 outcome (patient health): Regarding
patient health, P06 reported that the information contributed to avoid
unnecessary intervention and prevent health deterioration. “By keeping him on the medication, it
controls his diabetes, and it reduces the chances of developing side effects of
diabetes, or even making it worse. He went untreated for so long, that he has
probably been causing damage, but if we can control his sugar, it will
hopefully slow down the disease.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten Share information Manage patient care |
Reminded something Confirmed Reassured |
Justify choice Understand issue |
Prevent Avoid |