P15S09: Smoking cessation (medication / hepatic dysfunction)
Bottom line: Information on a treatment
for smoking cessation (bupropion) was used to justify the management of a patient with hepatic
dysfunction (lower dose of the medication). There were no information-related
patient health outcomes.
Level 1 outcome (situational relevance): On November 26, 2008, P15 did a search
at work, by themselves, while the nurse practitioner was in their office, and
after an encounter with the patient. They retrieved
one information hit about Zyban and hepatic dysfunction. The reported search objectives were: to address a clinical question, to
look up something they had forgotten, and to exchange information with other
health professionals. “She [the patient, a woman in her thirties] wanted to quit
smoking, but we were waiting for her liver enzymes [results] to come back
because she had shown that her liver enzymes were a bit elevated. [...] She had
mild to moderate hepatic impairment. […] The nurse practitioner got the results. […][The
clinical question was] what dose to give the patient which has mild
liver attack impairment of bupropion. […] Ididn’t know what the dose was. [...] I shared
information to this practitioner who was going then give the prescription to
the patient.” According to P15,
e-Therapeutics+ was the only source for information, and the found information
was relevant.
Level 2 outcome (cognitive impact): One hit was associated with a report of positive
cognitive impact (see table). Regarding practice improvement and learning, P15 stated: “If I have future patient with mild to
moderate hepatic impairment, I will know what the dose is [for Zyban]. […] I didn’t know
that you had to decrease dose for patients with mild to moderate hepatic
impairments.”
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): e-CPS Tab
– Keyword: Zyban
– Dosage – Dosage adjustments for
patients with impaired hepatic functions
(P15S09H01)
Level 3 outcome
(information use): Information on Zyban
and hepatic dysfunction was retrieved, and used to justify the management of
a patient (information used as presented in e-Therapeutics+). “I just told the nurse practitioner what the
dose was. She wrote the prescription for the patient. […]
Doses are lower than the recommended for people that have hepatic
dysfunctions. It was just to justify using this dose in this patient.”
Level 4 outcome (patient health): There was no
clear relationship between the use of information and patient health outcomes, and there
was no follow-up: “I haven’t followed up with the patient”.
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 |
Practice improved Learned something Confirmed Reassured |
Justify choice |
No outcome |