P18S03: Acne vulgaris
Bottom line:
Information on acne vulgaris, specifically drug interactions between
tetracyclines and warfarin, was used to justify
the management plan for a patient (switch back to previous prescription of
tetracycline), and to persuade other health professional to make this change. It contributed to
increase patient knowledge and to avoid inappropriate treatment.
Level 1 outcome (situational relevance): On August 20, 2008, P18 did a search at work, by themselves, and after
an encounter with a patient. They retrieved two information hits about drug interactions between Tetracycline and
Warfarin. The reported search objectives were: to
address a clinical question, to look up something they had forgotten, to share
information with a patient, to exchange information with other health
professionals, and to plan, manage or coordinate tasks with other health professionals. “She is a patient [a woman in her mid-thirties] who had a stroke at some point. That’s why she is on Warfarin. She also
has acne, and the doctor wanted to start her on Tetracycline. […] I think the doctor sent the prescription to
the pharmacists […] and said: ‘We should switch
to a different Tetracycline because of the interactions with Warfarin’. So, I
just wanted to double check and see if she was at risk to increase or decrease
INR [International Normalized Ratio] and if I should monitor more closely, if I should change the medication.
[…] I could not remember if all
the Tetracyclines would interact with Warfarin or if one was more likely
compared to another. […] The patient had already
bought the Tetracycline she was prescribed and so she […] wanted to know if she could continue the one
she’s already on, or if she really needed to change to another medication. […] We [P18 and doctor] needed to plan that the patient would need INR [International Normalized Ratio] done more often.” According to P18, the information from e-Therapeutics+ was in agreement
with and more relevant than the information from another electronic resource (Up-to-Date). “It [the information from Up-to-Date] was less thorough, [...] less complete.”
Level 2 outcome (cognitive impact): The two hits were associated with a report
of positive cognitive impact (see table). Regarding practice improvement, P18
stated: “ [My practice will be changed in the way
that] I’ve kind of refreshed on drug interactions
for Warfarin and it’s something I do fear that I might have in my clinic, so
it’s relevant to me. It’s useful. [...] [using e-Therapeutics+]
you can compare the different types of tetracyclines. It would have been easy
to see if one would interact more than another.”
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: Tetracycline – Acne – Table 2 Systemic drugs use for acne therapy (P18S03H01)
2) e-Therapeutics+ (CIRT): e-CPS Tab – Keyword: Warfarin – Warfarin sodium –Coumadin(M) – Drug interactions (P18S03H02)
Level 3 outcome
(information use): Information on drug interactions between Tetracycline and
Warfarin was retrieved, and used to better
understand a specific issue with respect to the management of the patient, to justify the
management plan for a patient (switch back to previous prescription of
tetracycline), and to persuade other health professional to make this
change (information used as presented in
e-Therapeutics+). “She [the patient] already started on the
Tetracycline. […] The doctor had documented in
the chart that she wanted the patient to change to a different [Tetracycline] one to avoid drug interactions. But [based on the information I found] it was the same
interaction. […] So the patient wouldn’t
need to change [the Tetracycline] medication. I wanted the doctor to change it back to the original
medication [cancel the newest prescription to keep the
previous Tetracycline].”
Level 4 outcome (patient health): Regarding patient health, P18 reported that the information
contributed to increase patient knowledge and avoid inappropriate treatment. “[…] When the patient came in to see the physician, [I went to] talk with her and educate her a bit more
about Warfarin. […] We managed; we monitored
her INR [International Normalized Ratio] a bit more closely to avoid issues […][like her] ending up with another stroke or bleed.”
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 Manage patient care |
Practice improved Motivated to learn Confirmed Reassured |
Persuade Justify choice Understand issue |
Avoid Patient knowledge |