P19S07: Attention-deficit hyperactivity
disorder (ADHD) : Drug dosage
Bottom line: Information on Attention-deficit Hyperactivity Disorder
(ADHD) was used to maintain the
management of a patient (confirm dosage of drug before re-prescription). There were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On November 28, 2008, P19 did a search at work, by themselves, and
after an encounter with a patient. They retrieved two information hits about dose of Dexedrine XR. The reported search objective was: to address a clinical question. “So this gentleman [an 18 years
old male with ADHD] was being seen by the social worker because […] he had no drug
insurance to cover the cost of medication, and he’s essentially homeless. We
were looking for a way to pay for his medication and eventually we realized
that his mother’s insurance paid for his meds. [The patient] had lost the prescription that the physician
had given him for Dexedrine. I just had to reprint the prescription for her [the
physician’s] signature. I just had to double-check that
the dose was in the right range and that I had the right product before I
printed the prescription.” According to P19, e-Therapeutics+ was the only source
for information, and the found information was relevant.
Level 2 outcome (cognitive impact): The two hits were associated with a report of positive cognitive
impact (see table). Regarding learning and practice improvement, P19 stated: “It was new information. […] I didn’t know
the dose range actually, because there is a range, it’s not a specific dose.
And […] I didn’t know what strength the spansules
[sustained release capsule] came in either. […] I think that in the future at least I’ll
have an idea of what dosage range of Dexedrine XR is.”
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): e-CPS Tab – Keyword: Dexedrine – Monograph – Dosage –
Attention deficit hyperactivity disorder in children (P19S07H01)
2) e-Therapeutics+ (CIRT): e-CPS Tab – Keyword: Dexedrine – Monograph – Dosage –
Supplied (P19S07H02)
Level 3 outcome
(information use): Information on dose of Dexedrine XR 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 of
the patient (information used as presented in e-Therapeutics+). “So the prescription was for 30 capsules, he [the patient] took one and
then his dog ate the other 29. […] My concern was did the dog really eat them
or did he sell them? The social worker and the physician are pretty confident
that the dog actually did [eat the capsules], that’s
totally consistent with this kid apparently. So he’s coming [the patient] back and
they’re going to start over. […][The management was maintained], I didn’t really
modify anything.”
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 |
Practice improved Learned something Reassured |
Be more certain Understand issue |
No outcome |