P17S09: Neuropathic pain management
(reduce medication)
Bottom line: Information on neuropathic
pain was used to modify the
management of a patient (stop some medication). There were no information-related
patient health outcomes.
Level 1 outcome (situational relevance): On November 5, 2008, P17 did a search at work, by themselves, and
after an encounter with a patient. They retrieved two information hits about neuropathic
pain. The reported search objectives were: to address a clinical question, and
to exchange information with other health professionals. “[The patient,
a female in her forties] was a referral from one of the GPs in the
clinic. […][She is] a patient with lots of medications. She’s
having some polypharmacy for her pain management. […] We are looking
to treat the neuropathic pain for this individual. […] The doctor
wanted to know if we could her get off some of these medications. So my
question was “is she on anything that wasn’t necessarily indicated for
neuropathic pain”. […] I was going to exchange that information if
it was something that wasn’t valid or it was something she was on that she
needed to be, I would be communicating that back to the GP. [...] [I knew] there were
some medications [Carbamazepine and Amitriptyline] that were
valid on her [the patient’s] profile.” According to P17, e-Therapeutics+ was the only source for information,
and the found information was relevant.
Level 2 outcome (cognitive impact): The first hit was associated with a report of
positive cognitive impact (see table). Regarding practice improvement, P17 stated: “I would still go to that drug [Carbamazepine]versus some of
the newer ones, just because they’re newer doesn’t necessarily mean they’re
better so,it’s good to know that the old ones still work the best. [It changed] my impression.”
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: Neurologic disorders – Neuropathic pain – Highlight (P17S09H01)
2) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: Neurologic disorders – Neuropathic pain – Table 3 (P17S09H02)
Level 3 outcome
(information use): Information on neuropathic pain was retrieved, and
used to modify the management of a patient (information
used as presented in e-Therapeutics+). “After I did my
search, I actually made recommendations to stop a couple of medications. […]We would be
keeping some drugs and changing others. […]I gave a written report to the physician and
he took it from there.”
Level 4 outcome (patient health): Health outcomes were unknown since there was no follow-up. P17 cannot
confirm the rating (expected outcomes) with clinical observation. P17: “I haven’t followed up.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Exchange information |
Practice improved Reminded something Confirmed Reassured |
Manage differently |
No outcome |