P14S07: Attention-deficit hyperactivity disorder
(ADHD) : Drug options
Bottom line: Information on Attention-deficit hyperactivity disorder
(ADHD) was used to
justify the management of a patient (avoid second line treatment). It
contributed to avoid inappropriate treatment.
Level 1 outcome (situational relevance): On September 17, 2008, P14 did a search at work, by themselves, and
before an encounter with a patient. They retrieved three information hits about ADHD. The reported search
objectives were: to address a clinical question, to share information with a patient or caregiver, and to exchange information with other health professional. The patients parents had brought in an article on this
[new] drug wondering about it for their child instead of stimulant medications [
]The patient [a teenager
girl] [and her] mom came in and they were asking about
treatment choices [for ADHD] and they were specifically asking about
Strattera which is Atomoxetine. [
] I needed more information about the
management of ADHD than the Pharmacist letter was giving me. [
] It [the Pharmacist
letter] was just kind of drug information and [it] talked about
some of the recent controversies around Strattera. [
] I had to talk
to the parents and the daughter about medication choices, [
] [and] I had to share
the information about the dosing of Concerta [the first line treatment] with the
physician. According to P14, the
information from e-Therapeutics+ was in agreement with and less relevant
compared to the information from another textbook or journal (Pharmacist
letter). The Pharmacist letter does a good job of
detailing the drug itself. [
] And then I went to Therapeutic Choices to
read up on the management [
].
Level 2 outcome (cognitive impact): Three hits were associated with a report of positive
cognitive impact (see table). Regarding learning, P14 stated: I learned something new from that whole
Atomoxetine paragraph [in the Pharmacologic choices section]. [And][
] I
didnt really know the place in therapy of this new agent for ADHD, Strattera, [
] it
puts it not first line. Regarding reminder, P14 stated: Im reminded of something I already knew [with] the
pharmacologic choices on psychostimulants (first hit) [
][and] the dosing of
methylphenidate (third hit).
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: ADHD Pharmacologic choices (P14S07H01 = L + RM)
2) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: ADHD Highlight (P14S07H02 = L)
3) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: ADHD Table 2: Drugs used in
ADHD (P14S07H03 = RM + D)
Level 3 outcome
(information use): Information on ADHD was retrieved, and used to justify the management of a patient
(information used as presented in e-Therapeutics+). I used this information to justify that it [Strattera] wasnt the
first line drug.
Level 4 outcome (patient health): Regarding patient
health, P14 reported that the information contributed to avoid
inappropriate treatment. [In the second]
encounter
was the physician, myself, the mom, the dad and the daughter. There were five
of us. [...] I said to them [the parents of the patient] that there is
a place for Atomoxetine in the treatment of ADHD, but its a relatively new
drug and that means its not first line, especially when you treat children. We
dont know everything there is to know about that drug yet so we probably
should stick with what we know for sure. [We avoided] going with the second line agent [Atomoxetine -
Strattera] [
].
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information Exchange information |
Learned something Reminded something |
Justify choice |
Avoid |