P11S05: Crestor and grapefruit
Bottom line: Information on Crestor and potential interaction with
grapefruit was used to justify the
management of the patient (new prescription for Crestor). It contributed to increase patient
knowledge, avoid an inappropriate treatment and prevent health deterioration.
Level 1 outcome (situational relevance): On May 15, 2008, P11 did a search at work, by themselves, and after an
encounter with a patient. They retrieved one information hit about Crestor and
grapefruit. The reported search objectives were: to address a
clinical question and to share information with a patient or caregiver. “The patient [a 75 year old man] was on
Crestor and his wife had been on Lipitor and had learned [from another
source] that she should not take grapefruit juice on
Lipitor, so she had asked the doctor to change her to Crestor. [...]When he [the patient] came in to
talk to me, he asked me to double-check that that [no
interaction between Crestor and grapefruit] was accurate [information].” According to P11, 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, P11 stated: “I didn’t know that Crestor was an exception
to the grapefruit interaction. I knew that classic drugs had a grapefruit
interaction, [but] I didn’t know that Crestor was accepted. [My practice
will be changed because] it may improve the quality of life for my
patients.”
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): e-CPS tab – Brand and generic – Keyword: Crestor – Warnings and precautions – Drug interactions Tab – Lexi-interact – Keywords: Crestor and grapefruit – Analyze (P11S05H01)
Level 3 outcome
(information use): Information on Crestor and grapefruit was
retrieved, and used to justify the management of the patient (information used
as presented in e-Therapeutics+). “The patient had
a new prescription for Crestor [for his wife] and was not going to change their medication
if the same restriction on grapefruit juice was going to apply.”
Level 4 outcome (patient health): Regarding patient
health, P11 reported that the information contributed to increase patient
knowledge, to avoid an inappropriate treatment and to prevent health
deterioration. “They [the patient
and his wife] are much more cooperative about taking their
cholesterol medication, now that they know it does not interfere with [...] what they
perceive to be positive, which is “grapefruit juice is healthy”. [...] This way [by taking
Crestor], they won’t change to another medication
that may be less effective, because it [the effectiveness] was a big issue
for the patient. [...] [Crestor] will will help
lower their cholesterol. [Crestor] improved [their] [the patient
and his wife’s] quality of life.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information |
Practice improved Learned something |
Justify choice |
Prevent Avoid Patient knowledge |