P21S02: Acute otitis
media
Bottom line: Information on acute otitis media was used to maintain the management of a patient
(prescribe clarithromycin). There were no information-related patient
health outcomes.
Level 1 outcome (situational relevance): On February 2, 2009, P21 did a search at home, by themselves, and
after an encounter with a patient. They retrieved two information hits about clarithromycin. The reported search objective was: to fulfill an educational objective,
to look up something they had forgotten, and to share with family caregivers. “He [the patient, a sixteen years old boy] was presenting
with an ear infection. [...] He told me that he was previously treated
with Biaxin, which is a second line antibiotic for ear infections because he’s
had so many. [...] When he was younger they gave him
amoxicillin, which is sort of the first line antibiotic, and he stopped
responding to it, that’s why I gave him Biaxin. So I was obviously going to
represcribe Biaxin. [...] [I wanted to] read a bit
about the dosage [in adults and children] [...] to see if it
was a big difference […] to tell the
parents if needed. […] He was sixteen years old but he had the body
of an adult. [...] I wanted an answer and my objective was to
find the dosage and I found it. [...] I was definitely taught the dose of Biaxin,
but I forgot it.” According to P21, e-Therapeutics+ was the only source
for information (patient reviewed with the supervisor), and the found
information was relevant.
Level 2 outcome (cognitive impact): The first hit was associated with a report of positive cognitive
impact (see table). Regarding confirmation, reassurance and reminder, P21 stated: “I forgot the
dose [in adults] and it reminded me of the dose. […][It
confirmed I was doing the right thing] because I never prescribe a medication
without reviewing or with someone knowing the dose, […] I wanted to
double check the dose. […] I’m sort of basing that answer after the
fact. It confirms that I’m definitely giving the right antibiotic for the [right] problem.” The second hit was associated with a report
of a highly positive cognitive impact (learning). “I didn’t know the dose per kilo [in children].”
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): e-CPS – Clarithromycin– Biaxin– Table 15Adults (P21S02H01)
2) e-Therapeutics+ (CIRT): e-CPS – Clarithromycin– Biaxin– Table 17 Children (P21S02H02)
Level 3 outcome
(information use): Information on Biaxin 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 a patient (information used as presented in e-Therapeutics+). “This information helped me to better
understand the dose [and] to maintain [my management]. [...] I just wanted [...] to double
check, [...] I didn’t have to make any changes.”
Level 4 outcome (patient health): Without these
information hits, P21’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 |
|
Fulfill educational objective Look up something forgotten Share information |
Learned something Reminded something Confirmed Reassured |
Be more certain Understand issue |
No outcome |