P19S01: Acne rosacea

Bottom line: Information on acne rosacea was used to maintain the management of a patient (treatment of acne rosacea with minocycline or doxycycline). There were no information-related patient health outcomes.

Level 1 outcome (situational relevance): On August 19, 2008, P19 did a search at work, by themselves, and after an encounter with a patient. They retrieved one information hit about interaction between calcium and tetracycline (minocycline and doxycycline). The reported search objectives were: to address a clinical question, to look up something they had forgotten, to share information with the patient and to exchange information with other health professionals. “The lady [in her late seventies] came in for a medication review because she has polypharmacy. [...] She had previously been taking tetracycline, cyclically, for rosacea. [...]. She was also on calcium supplements for her osteoporosis [and] I seem to remember, from past reading, that [generic] tetracycline and calcium interacted, and I thought that [some tetracyclines such as] minocycline and doxycycline [...] didn't interact with calcium, but I wanted to refresh my memory. [...] [My question was]: would minocycline or doxycycline be a better choice [than generic tetracycline] if she [the patient] needed to treat her rosacea again. [...] If I recommend a change, then I always explain to the patient why I suggested that[...][and]I have to explain my rationale to the physicians, so that they write a prescription for the new drug.” According to P19, the information from e-Therapeutics+ was less relevant than the information from another electronic resource (Facts and Comparison). “It was kind of in between [e-Therapeutics (no food restriction) and e-CPS (interaction with milk)]: there was a possibility of an interaction with doxycycline and minocycline, but it also said you could use them together.”

Level 2 outcome (cognitive impact): Two hits were associated with a report of positive cognitive impact (see table). Regarding learning, P19 stated: “[...] I thought that minocycline and doxycycline didn't really have to be separated [the drug intake], [but I have learned that] you do, really, [need to separate the intakes].”

Retrieved information hits:

1) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: Skin disorders – Rosacea chapter – Table 5: Oral drugs for the treatment of rosacea – Rows on tetracycline, minocycline and doxycycline – Drug interaction (P19S01H01)

2) e-Therapeutics+ (CIRT): eCPS Tab – ClinInfo – Drug interaction tools – Drug administration and food – Keywords: tetracycline, minocycline and doxycycline – Create table (P19S01H02)

Level 3 outcome (information use): Information on acne rosacea was retrieved, and used to maintain (be more certain about) the management of a patient (information from e-Therapeutics+ was used as presented). “Before, she [the patient] was using [generic] tetracycline for her rosacea, and now, in the future, if she needs oral antioxidant, it will be either minocycline or doxycycline.”

Level 4 outcome (patient health): Without these information hits, P19’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 Confirmed Reassured	Be more certain	No outcome

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