P14S05: Drug interaction (Warfarin and statins)
Bottom line: Information on drug
interaction (Warfarin and statins) was used to better
understand a specific health issue about a patient (drug dosage). There were no
information-related patient health outcomes.
Level 1 outcome (situational relevance): On December 5, 2008, P14 did a search at work, by themselves, and
before an encounter with a patient. They retrieved two information hits about Drug interactions (Warfarin and statins). 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 physician
was having trouble normalizing his [the patient, a man over 50 years old] INR
[International Normalized Ratio]. It [the INR] had been in control for quite a while and all
of a sudden [it] was changing. […][The physician asked for an assessment of] the
medications and anti-coagulation control of this patient who’s INR have recently
been in and out of target. […] [I searched e-Therapeutics+ to] put together
some information and talk to the doctors about it.” According to P14, the information from e-Therapeutics+ was in agreement
with and equally relevant as the information from another electronic resource (Micromedics).
Level 2 outcome (cognitive impact): Two hits were associated with a report of positive cognitive impact (see table). Regarding reassurance
and reminder, P14 stated: “I was reminded [and] I was
reassured because my memory wasn’t as bad as I thought it was! […] The statins
have variable effects on the INR and I couldn’t remember which ones were worse.” Regarding learning, P14 stated: “[…] The
Fluvastatin, which is a drug we don’t use much anymore, but I didn’t realize it
was an enzyme inhibiter. […] It [the retrieved information] confirmed that
the effects on Warfarin are variable and that being cautious is the proper
thing to do. […][It] reassured [me] that I’m not overly cautious for no reason.”
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): Drug interactions Tab – Keyword: Warfarin andAtorvastatin – Analyse
–Warfarin link – Whole page (P14S05H01)
2) e-Therapeutics+ (CIRT): eCPS – Clinical information– Drug interactions tools– Cytochrome P450 drug interactions – Keywords: R-Warfarin – S-Warfarin – Atorvastatin – SIMV – ROSU – FLUV – PRAV (all add to list) –Create table (P14S05H02)
Level 3 outcome
(information use): Information on drug interaction (Warfarin and statins) was retrieved,
and used to better understand a health issue (drug dosage taking this
interaction into account) (information used as presented in e-Therapeutics+). “[…] I pulled the information together and I put
it into a consult [sic] and I made a recommendation.[…][I wanted] the doctor [to change] the dose.
[However], the patient was in yesterday… but there’s nothing in
the chart about his Warfarin because they are doing that on paper, they have
half electronic, half paper charts. [So, you don’t know?] Not yet.”
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 |
Learned something Reminded something Confirmed Reassured |
Understand issue |
No outcome |