P28S06:
Chest pain
Bottom line: Information on acute
coronary syndrome was used to modify the management of a patient (potential drug interaction and
no use of nitrates). It contributed to increase patient knowledge, and
avoid inappropriate treatment.
Level 1 outcome (situational relevance): On May 19, 2009, P28 did a search at work, by
themselves, and during an encounter with a patient. P28 left the examination
room, retrieved one information hit about acute coronary syndrome, and went back to the room.. The reported search objective was to search in
general or for curiosity. . “[We
had] a gentleman [between 60 and 70 years
old] [in the Emergency Department, and he] was having chest pain. […]
I looked
up acute coronary syndrome because I was afraid he was having a heart attack.
[…] I saw the patient, we stabilized him […]
and I logged [into e-Therapeutics+]
later […] to refresh myself. [Were you doing the search
thinking about the patient?] No. That’s the thing, like I, I was just reviewing
it [the information]. [Okay, that’s what I thought, like you were killing time,
in eT or something?] Sort of, yeah. […] Sildenafil and all those other medications
are like Viagra, they’re phosphodiesterase-5 inhibitors.
[…] When I saw […] the
part on nitrates in green [the Highlight], […] I went back to the patient.[…] I
just wanted to ask him [if he had taken Viagra],
just to make sure. […] We
couldn’t give him nitrates to lower his blood pressure because he had taken
Viagra in the previous 24 hours.” According to P28,
e-Therapeutics+ was the only source for information, and the found information
was relevant.
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding learning, P28 stated: “I learned the specific
phosphodiesterase-5. I know that there’s Viagra, but then there’s also
Sildenafil, which is, I believe Cialis, and Vardenafil also, which is another
one. I know now that nitrates combined with phosphodiesterase-5 inhibitors
cause a drop in blood pressure acutely, which can, you know, kill the patient.”
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): Therapeutics Tab – Acute coronary syndromes –
Highlight (P28S06H01)
Level 3 outcome
(information use): Information on acute coronary syndrome was
retrieved, and used to maintain (be more certain about) a medication, and to modify
the management of a patient (information used as presented
in e-Therapeutics+). “Once
I knew he [the patient] was
on nitrates, I modified his treatment. [...] He
was on other medications besides the nitro, so I kept the other medication, but
I changed the fact that I gave him something else to drop his blood pressure.”
Level 4 outcome (patient health): Regarding patient health, P28 reported that the
information contributed to increase patient knowledge, and avoid inappropriate
treatment. The patient “got stabilized… I
believe cardiology saw him… The next day, he was given some medication, and
sent home. […] For patient education, I told him that the next
time he comes to the emergency room with chest pain, that he should say that he
was on Viagra. Because I guess he may have been a bit too shy to say that he
had taken medication, but it is quite important, it’s life-threatening.
[…] I think the unnecessary and inappropriate
treatment is the use of a nitrate in the presence of Viagra or any other sort
of, that class of medication.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Satisfy curiosity |
Learned something Reminded something Motivated to learn Confirmed Reassured |
Manage differently Be more certain |
Avoid Patient knowledge |