P12S07: Neuropathic pain management (combine drugs)
Bottom line: Information on management of neuropathic pain (combination
of Lyrica and OxyContin) was used to maintain the management of the patient (medication). There
were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On November, 2008, P12 did a search at work, by themselves, and during
an encounter with a patient. They retrieved two information hits about usual management of neuropathic pain. The reported
search objective was to address a clinical question. [The patient,
a woman between 20 and 30 years old] is a customer that we actually fill weekly
[
] for OxyContin [medication]. I think 30 mg
three times a day or something like that, plus the drugs to treat the
constipation and all that kind of stuff. But she came in and showed me the
sample of Lyrica and said that the doctor had given it to her and she just
asked what I thought about that, [
] [about] the role of Lyrica in the
management of neuropathic pain. [
] Lyrica actually works differently than the
Opiate in the management of neuropathic pain, and so therefore the combination
might be very effective for her [the patient]. Her [the patient] main concern
was the addiction to the Opiate, so I kind of reassured her that by using the
combination, she might be able to cut back on her Opiate dose. According to P12, the information from e-Therapeutics+ was in agreement
with and equally relevant as the information from another paper-based resource
(Pharmacist letter). [
] Each
of them [e-Therapeutics+ and the Pharmacist letter] separately provided [me] some information, which together, sort
of
completely answered it [the clinical question].
Level 2 outcome (cognitive impact): The two hits were associated with a report of
positive cognitive impact (see table). Regarding confirmation, reassurance, and reminder, P12 stated: I already knew that Lyrica was very effective
[for neuropathic pain]. I had other patients [for whom] Lyrica was beneficial,
so I just wanted to basically reassure this patient that it [prescribing
Lyrica] was a reasonable thing for the doctor to be doing. [
] It [the first
information hit retrieved] basically supported what I was telling her [with
respect to P12S07H01]. It [the second
information hit] just kind of puts the whole picture in perspective. [
] [It
confirms that] I sort of know about the management of neuropathic pain in
general [with respect to P12S07H02].
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: Neuropathic pain Pharmacologic choices Chronic peripheral neuropathic pain (P12S07H01)
2) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: Neuropathic pain Printed whole page (P12S07H02)
Level 3 outcome
(information use): Information on management of
neuropathic pain 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 of the patient
(information used as presented in e-Therapeutics+). She [the patient] already had the sample [of
Lyrica] so it [the information retrieval] was kind of justifying that the
sample [the sample medication of Lyrica] that the doctor had given her was a
reasonable thing.
Level 4 outcome (patient health): Without this information hit, P12s management of the patient would have been
the same. There was no clear relationship between the information use and
patient health outcomes.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question |
Reminded something Confirmed Reassured |
Be more certain Understand issue |
No outcome |