P10S05: High
blood pressure, type II diabetes and kidney function
Bottom line:
Information on high blood pressure, type II diabetes and kidney function was
used to maintain the management plan for a patient (medication change), and to
persuade a patient to make this change. There were no information-related
patient health outcomes.
Level 1 outcome (situational relevance): On December 12,
2008, P10 did a search at work, by themselves, and before an encounter with a
patient. They retrieved one information hit about Avapro [Angiotensin II
Receptor Blocker - ARB]. The search objectives were: to address a clinical
question, to look up something they forgot, to share information with a
patient, to exchange information with other health professionals, and to plan,
manage, coordinate, delegate or monitor tasks with other health professionals.
“[The patient was] an eighty-two old man
with type II diabetes. [...] I was worried about his kidney function, so I was
thinking, if I switched [from ARB+thiazide] to Avapro [ARB] it would help
kidney function and that’s actually recommended. So I just was in the process
of doing the switch, and I knew I was going to switch to Avapro, because that’s
the one I am most comfortable with and I just wanted to review [before the encounter].
[...] [My question was] what do I have to be aware of in switching or in
starting Avapro with a geriatric patient. [...] I certainly did talk to the
doctor that I work with about it, and then I actually talked to the nurse
practitioner I worked with today about it. And, then I certainly shared it with
the patient, why I wanted to switch him, even though his blood pressure was
good. Why it was important that I thought to switch to this medication? [...]
Just because he’s eighty-two and he’s type II diabetes and he has an
amputation, I run it by the doctor I work with.” According to P10, the
information from e-Therapeutics+ was in agreement with and equally relevant as
the information from another professional (physician), and it was in agreement
with and more relevant than the information from another paper-based resource
(pharmacy textbook). “It [the book]
wasn’t nearly as detailed, but it didn’t disagree [with e-Therapeutics+].”
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive
impact (see table). Regarding confirmation, reassurance, and reminder, P10 stated: “[The information] just agreed with and
validated what I was thinking before I had done the search. [...] It didn’t
change my practice, because it was already what I thought. [...] It would be
just impacting by reassuring me. […] It just validated my thoughts.”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT): e-CPS tab – Avapro – whole page with
focus on increases in blood urea nitrogen (BUN) & creatinine clearance
(P10S05H01)
Level 3 outcome
(information use): Information on Avapro was retrieved, and
used to better understand a specific issue with respect to
the management of the patient, to maintain (be more
certain about) the management plan for a patient (medication change), and to
persuade the patient to make this change (information used as presented in
e-Therapeutics+). “I have changed him; I
have started him on Avapro. [...] It wasn’t the website that led me to modify
it [my management]. I was already going to modify it and I was trying just to
use it to make sure that this was ok to modify it. […][The information was also
used] to reassure the patient why I was doing it, that there was a valid reason
and that it was ok to do it. [So it was used to persuade the patient].”
Level 4 outcome (patient health): There was no
clear relationship between the use of information and 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 Share information Exchange information Manage patient care |
Reminded something Confirmed Reassured |
Persuade Be more certain Understand issue |
No outcome |