P20S08: Parkinson’s disease

Bottom line: Information on Parkinson’s disease was used to maintain the management of a patient (not re-starting dopamine agonist). There were no information-related patient health outcomes.

Level 1 outcome (situational relevance): On October 28, 2008, P20 did a search at work, by themselves, and after an encounter with a patient. They retrieved two information hits about Parkinson’s disease to address a clinical question. “He [the patient, a man in his late sixties] had recently stopped the dopamine agonist. […] He did have some hypersexual behaviour. He had got a little better after he stopped this medication. […]But he was also having trouble on levodopa, […] [and] on entacapone [catechol-O-methyl transferase (COMT) inhibitors]. I was looking at whether we could use a different dopamine agonist.” According to P20, the information from e-Therapeutics+ was in agreement and equally relevant as the information from another electronic resource (RX-Files).

Level 2 outcome (cognitive impact): Two hits were associated with a report of positive cognitive impact (see table). Regarding confirmation, reassurance and reminder, P20 stated: “I’ve used these drugs in this way before. The patient wasn’t on this drug anymore [dopamine agonist], but due to the hypersexual behaviour, I think I might have recommended stopping it, [to reduce] the day time sleepiness [that he] was experiencing [as well]. [The highlight] was confirming information I knew, which is reassuring. Almost everything there is [something that] I already knew: pulmonary fibrosis with bromocriptine, the daytime drowsiness and sleep attacks, increased gambling, increased hypersexual behaviour, etc.”

Retrieved information hits:

1) e-Therapeutics+ (CIRT): Therapeutics Tab – Home page – Parkinson – Dopamine agonists – Highlight (P20S08H01)

2) e-Therapeutics+ (CIRT): Therapeutics Tab – Home page – Parkinson – Pharmacologic choices- Levodopa, dopamine agonists and COMT inhibitors (P20S08H02)

Level 3 outcome (information use): Information on dopamine agonist was retrieved, and used to maintain (be more certain about) the management of the patient (information used as presented in e-Therapeutics+). “He [the patient] had recently stopped the dopamine agonist, and he had to consider whether he wanted to restart that one. So I helped him to decide for his therapy [not re-starting]. And I helped him to come up with some questions to ask his neurologist.[…] Some of the drugs were changed and he still not well controlled. He’s declined quite a bit, […] his Parkinson’s had advanced.”

Level 4 outcome (patient health): Without these information hits, P20’s management of the patient would have been the same. There was no clear relationship between the information use and patient health outcomes (information maintaining the management and found after the consultation).

Levels of outcome of information-seeking

Situational relevance	Positive cognitive impact	Information use	Patient health
Address a clinical question	Reminded something Confirmed Reassured	Be more certain	No outcome

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