P14S04: Drug interaction (statins and grapefruit)
Bottom line: Information on statins drug
interactions was used to better understand
a specific health issue about a patient (interaction between grapefruit and some statins). There were no
information-related patient health outcomes.
Level 1 outcome (situational relevance): On July 15, 2008, P14 did a search at work, by themselves, and after
an encounter with a patient. They retrieved one information hit about drug
interactions (statins and grapefruit juice). 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 patient [a 74-year-old
male] [came to the] diabetic clinic visits. [
][The] very well
controlled [diabetic patients] are seen by a
dietician, theyre seen by a pharmacist, and theyre seen by a nurse
practitioner. [
] I did my regular questions that I will ask
diabetic patients and I found out that he [the patient] ate grapefruit every day. [
] This man, his
cholesterol was elevated and I knew, because he was a diabetic, [that] they [physician or
nurse practitioner] would want to put him on a drug to decrease
his cholesterol. I also knew that he ate grapefruit, and grapefruit interacts
with some of the drugs in that group but not all of them. So, I had to go
refresh my memory by building that chart. So, I could recommend [the right
statin] to the physician or the nurse practitioner,
if there were going to start a statin. According to P14, the information from e-Therapeutics+ was in agreement
with and equally relevant, as the information from another textbook or journal
(Rx files).
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding confirmation,
reassurance, and reminder, P14 stated: I'm always asking a question about grapefruit
juice and recognizing that there are drugs that cant be given with it. [...] I already knew
that these drugs [the statins] interacted with grapefruit juice, but I
couldn't remember which ones. [...] I'm reminded of the details of something I
already knew.
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): e-CPS Clinical information Drug interaction tools Cytochrome P450 drug interactions Keywords: Grapefruit juice and Rosuvastatin Create table
(P14S04H01)
Level 3 outcome
(information use): Information on drug interactions (statins and grapefruit juice) was retrieved,
and used to better understand the health issue, i.e., a potential interaction
between grape and a potential treatment (information used as presented in
e-Therapeutics+). He's
not on a cholesterol lowering drug yet. [...]I didn't want to have to change the
prescription after it was written. [I wanted] that when the physician wrote the
prescription, they wrote for the right statin.
Level 4 outcome (patient health): Not applicable
(conceptual use).
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 |
Reminded something Confirmed Reassured |
Understand issue |
No outcome |