P14S03: Atrial
fibrillation
Bottom line: Information on atrial fibrillation was used to modify the management plan of
the patient (drug already stopped, and not re-started with higher dose), and to
persuade another
health professional to make changes (no increase of drug dose). It contributed to avoid inappropriate
treatment.
Level 1 outcome (situational relevance): On August 5, 2008, P14 did a search at work, by themselves, and after
an encounter with a patient. They retrieved two information hits about atrial fibrillation. The reported search objectives were: to address a clinical question, to
look up something they had forgotten, and to exchange information with other
health professional. [
] The resident had seen this patient [a man in his
forties] [
] who was having [
] atrial
fibrillation [
] symptoms. The resident had said: he [the patient] failed Sotalol,
is there anything else we can use in this case?" And then, he [the resident] had said:
"really, hes [the patient] that young, maybe he should have catheter
ablation [ablation of the left atrium] ". [
][I] had to build my own knowledge base, before I
could [answer]. [
]. I had said to the resident "I think
Diltiazem is also an option [for] this patient, but I will go double-check,
because I didn't know if Diltiazem was an option if [they] [the patient] were
symptomatic. According to P14, the information from e-Therapeutics+ was relevant.
Level 2 outcome (cognitive impact): The first and the third hits were associated
with a report of positive cognitive impact (see table). Regarding reminder, P14 stated: I was reminded [
] that Sotalol,
which is another drug, has rhythm control as well as rate control [for atrial fibrillation]. The second hit was associated with a report
of highly positive cognitive impact (learning). I didn't know that atrial fibrillation [with symptoms]
was treated differently than asymptomatic [atrial
fibrillation].
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: Atrial
fibrillation Supraventricular
tachycardia Table 5: Drug
therapy for control of heart rate (P14S03H01)
2) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: Atrial fibrillation Supraventricular tachycardia Non-pharmacologic
choices (P14S03H02)
3) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: Atrial fibrillation Supraventricular tachycardia Non-pharmacologic
choices Catheter ablation Pharmacologic choices Printable version (P14S03H03)
Level 3 outcome
(information use): Information on atrial
fibrillation was retrieved, and used to better understand a
specific issue with respect to the management of the patient, to modify the management plan of the patient (drug already stopped, and
not re-started with higher dose), and to persuade other
health professional to make change (information used as
presented in e-Therapeutics+). I actually
printed the section (information) and gave it to the resident [...]. The patient
actually wasn't responding to Sotalol, and the resident wanted to know if [
] there was any
use in putting the drug higher and I said "no" youve reached your
target dose. [
] I had to convince the resident that there
was not really much use in going higher. I had to use this information to
convince him. [
] And so, what the resident decided was he
wouldn't increase the dose of Sotalol, because the patient was going to see a
cardiologist quite soon.
Level 4 outcome (patient health): Regarding patient
health, P14 reported that the information contributed to avoid
inappropriate treatment. [
] We avoided going
to a higher dose that might have had adverse effects on the patient, but not
any better outcomes in the treatment.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten Exchange information |
Learned something Reminded something Reassured |
Persuade Manage differently Understand issue |
Avoid |