P08S02: Secondary prevention of stroke
Bottom line: Information on the secondary
prevention of ischemic stroke was used to persuade a health professional to
make a change (not prescribing combination therapy). There were no
information-related patient health outcomes (no follow-up).
Level 1 outcome (situational relevance): On August 8,
2008, P08 did a search at work, by themselves, and after an encounter with a
patient. They retrieved one information hit about ischemic events. The reported
search objectives were: to search in general or for curiosity, to exchange
information with other health professionals, and to plan, manage, coordinate,
delegate or monitor tasks with other health professionals. “It was a patient [in his mid-seventies] who
had a stroke, who had an ischemic stroke, and I was just evaluating to see
whether the combination therapy would have any more benefit. […] I remember
that I’d had a discussion with a physician about it and we are going to have a
discussion about it later. […] [And] that was just to look at protocol. […]
Part of it was the patient was asking if they had to be on it because they
found Plavix too expensive.” According to P08, 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 practice improvement, P08 stated: “There’s
no reason to advocate for combination therapy. […] The use of aspirin or Plavix
alone will suffice in terms of risk reduction. […] This is kind of a
controversial thing. I never knew for sure if the combination was better or
not. […] I have had patients with cardio-vascular risks, post-stroke and I’ve have
some patients on both combination and regular therapy. It just helped to
confirm that you don’t have to have combination therapy whereas I had heard in
the past that, depending on the patient, you might want to have combination
therapy. […] [So my patients that are on the combination, I would change that
in the future.] […] Even in the case of a patient who’s already had a stroke,
you don’t have to use combination therapy.”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT):
Therapeutics tab –- Highlight (P08S02H01)
Level 3 outcome
(information use): Information on ischemic events was
retrieved, and used to persuade another health professional to make a change
(information used as presented in e-Therapeutics+). “I just used it [the information] as it was. […] I actually transferred
this patient to another practitioner. […] I didn’t actually justify or I didn’t
actually change the management of the patient. But I did document the
information and pass it on to the receiving physician, the colleague.”
Level 4 outcome (patient health): There was no
clear relationship between the information use and patient health outcomes. The
information was found after the encounter (not exchanged with the patient), and
there was no follow-up, so we do not know whether the management was changed
(or not).
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Satisfy curiosity Exchange information Manage patient care |
Practice improved Learned something Motivated to learn Confirmed Reassured |
Persuade |
No outcome |