P18S01: Gout (secondary prevention)
Bottom line: Information on gout, specifically allopurinol for secondary
prevention of gout, was used to
maintain the management plan for a patient (prescription of allopurinol). There were no
information-related patient health outcomes.
Level 1 outcome (situational relevance): On August 26, 2008, P18 did a search at work, by themselves, and after
an encounter with a patient. They retrieved two information hits about use of
allopurinol for prophylaxis of gout. The reported search objectives were: to address a
clinical question, to look up something they had forgotten, to share
information with a patient, and to exchange information with other health
professionals. “[The patient] was a man, [...] sixty eight [years old]. [...] He was
referred to me [...] and I discovered that he is taking indomethacin daily for
a prophylaxis of gout instead of for acute attacks so I needed to change it. So
I wanted to go and look to find all the information to present to the doctor so
I can get him to change the medication to allopurinol. [...] I was looking for
information on dose and side effects. [...] I couldn’t remember the dosing of
allopurinol for propylaxis. [...] I had to tell the patient that I was going to
check [...], that I would call back to his pharmacists or to him and to let him
know what we were going to do. [...] So, I sent an email to a doctor and got
him to find any prescription for me, so I could change the medication.” According to P18, the information from e-Therapeutics+ was in agreement
with and equally relevant as the information from another electronic resource (Up-to-Date). “In terms of drug info it was similar. [...]
Probably equally relevant, but less easy to use [compared to e-Therapeutics+].”
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding
learning, motivation, confirmation, reassurance and
reminder, P18 stated: “[I learned from] the green highlight about
Probenecid and sulfinpyrazone being a substitute, but it wasn’t really
applicable for my patient (concerning P18S01H01). [...] I had thought that I
was going to use allopurinol, and I just confirmed that it was a good choice
for this patient and that it didn’t have any contraindications. […] I already
knew the dosing and that it had to be [adapted] for kidney chronic patients,
but I just can’t remember the dosing adjustments (concerning P18S01H02).”
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: Allopurinol – hyperuricemia – Highlight (P18S01H01)
2) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: Allopurinol – hyperuricemia – Dosing and side effects of
allopurinol in Table 4 (P18S01H02)
Level 3 outcome
(information use): Information on allopurinol
for prophylaxis of gout was retrieved, and used to better understand a specific issue with respect to the management of
the patient, and to maintain (be more certain about) the management
plan for the patient (information used as presented in e-Therapeutics+). “I wanted to change from indomethacin to allopurinol.
[...] I needed to able to get the doctor to make a change so I wanted to have
the data to be able to justify why I wanted to change. […] He [the doctor]
didn’t really tell me anything. He just agreed with me.”
Level 4 outcome (patient health): Without
these information hits, P18’s management of the patient would have been the
same. There was no clear relationship between the information use and patient
health outcomes.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten Share information Exchange information |
Learned something Reminded something Motivated to learn Confirmed Reassured |
Be more certain Understand issue |
No outcome |