P13S07: Migraine
(try another triptan)
Bottom line: Information on migraine was used to justify the management of the patient (try a different
Triptan). It contributed to improve health of the patient.
Level 1 outcome (situational relevance): On November 7, 2008, P13 did a search at work, by themselves, and
during an encounter with a patient. They retrieved two information hits about Triptans.
P13 searched outside the consultation room, and then shared found information
with the nurse practitioner and the patient. The reported search objective was: to address a
clinical question. She [the patient, a
woman in her forties] had come in with a migraine headache, [and] had been
treated previously with two other Triptans, [
] as well as Ibuprofen and was still not having
any effect. [
][The clinical question was] that if the
patient failed two other Triptans, might an alternate Triptan be possibly still
effective. And the highlight had stated that although the differences are
small, they might be clinically relevant to patients. [
] So I thought [that] maybe another
trial of another Triptan might be effective. According to P13, e-Therapeutics+ was the only source for information,
and the found information was relevant.
Level 2 outcome (cognitive impact): The three hits
were associated with a report of
positive cognitive impact (see table). Regarding learning, P13 stated: [
] I had felt that it [to try a
different Triptan] was an option, that if a person has tried
one, it doesnt mean that they are going to fail every other Triptan. So it
sort of confirmed what I thought was true in the first place. [
] [But] I would say
that there was a couple at least one Triptan that I wasnt aware of, that was
on the list so that was new to me. [
] I was reassured I guess because [to change the
Triptan] seemed to be the most obvious choice, that
there really werent any other options that we hadnt already tried.
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword:
Migraine Headache in Adults Symptomatic treatment Section and Others Section until Prophylactic
therapy Section (P13S07H01).
2) e-Therapeutics+ (CIRT):
Therapeutics Tab Keyword: Migraine Headache in Adults Printable version of Table 2 (P13S07H02).
3) e-Therapeutics+ (CIRT):
Therapeutics Tab Keyword: Migraine Headache in Adults Symptomatic treatment Section Highlight (P13S07H03)
Level 3 outcome
(information use): Information on Triptans was retrieved, and used to justify the
management of the patient (information used as presented in e-Therapeutics+). We sort of reviewed the treatment options as
listed in the symptomatic treatment options of that section. And now, basically
the patient had already tried almost everything from those sections but,
because they [the patient] just tried a couple of Triptans, then we
agreed on doing a trial of a third Triptan, to see if they [the patient] might have
better luck with another one. [
] It [the retrieved information] gave us a lot
of options so it helped us. It helped to justify the option that we chose based
on what she [the patient] tried and failed in the past.
Level 4 outcome (patient health): Regarding patient
health, P13 reported that the information contributed to improve health of the
patient. [The
patient] called back and left a message to say that it did work to a small
degree. [...] She still had a bit of a persisting headache in which she had now
been taking some more Ibuprofen. [
] I hoped that it would treat her [the patient] to the point
where the migraine didnt get worse, it actually got better. [
] Based on her response that it worked
somewhat, there seemed to be some improvement.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question |
Learned something Reminded something Confirmed Reassured |
Justify choice |
Improve |