P10S06: Migraine
with aura and oral contraception
Bottom line:
Information on migraine with aura and oral contraception was used to justify
the management of a patient (patient education). There were no
information-related patient health outcomes.
Level 1 outcome (situational relevance): On November 7,
2008, P10 did a search at work, with a student, and after a phone call with a
patient. They retrieved two information hits about Micronor. The search
objectives were: to address a clinical question, to look up something they
forgot, and to share information with a patient. “[The patient] was a female [in her early twenties] that had migraines
and she had been put on another birth control pill and I know I switched her to
the Micronor. [...] She had migraines and someone else had started her on an
oral contraceptive that has both estrogen progesterone and I have said “we
can’t do that, because she has the migraine with aura”, and I explained why.
And then the search was done because she actually phoned me back. And she was
not having a period. And that was the concern. [...] I think she went and talk
to the pharmacist and she was getting different messages and hearing different
things, so she phoned me I think months after we have done the switch [to
Micronor]. [...] My question was to find out if being on Micronor would result
in amenorrhea. I know the other ones [oral contraceptives] can do it, but I
hadn’t realized that Micronor could. [...] She [the patient] was quite
concerned by this, because I hadn’t warned her because I hadn’t known to warn
her.” According to P10, the information from e-Therapeutics+ was in
agreement with and equally relevant as the information from other professionals
(physician and student), and from another electronic resource (Google),
Level 2 outcome (cognitive impact): Two hits were associated with a report of positive cognitive
impact (see table). Regarding practice improvement, P10 stated: “This
piece ended up teaching me something. [...] [And my practice will be changed
and improved] because I will now warn other people just on this [possible
amenorrhea], that there may be an issue.”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT): e-CPS tab – Micronor – warning on
vaginal bleeding section (P10S06H01)
2) e-Therapeutics+ (CIRT): e-CPS tab – Micronor – adverse effects
section (P10S06H02)
Level 3 outcome
(information use): Information on Micronor was retrieved, and
used to better understand a specific issue with respect to
the management of the patient, and to justify the management of the patient
(information used as presented in e-Therapeutics+). “I just reassured her that this was normal and that this stuff happens.
[...] I didn’t realize it would happen so quickly with Micronor. [...] I talked
to her for quite a bit about this, and I wished to say “ok, this is the only
birth control pill you can be on; you only have this choice or nothing.
Level 4 outcome (patient health): There was no
clear relationship between the use of information and patient health outcomes.
There was no follow-up. As stated by P10: “I
think she chose this [continue Micronor], but I’m not sure now if she’s still
on it or not.”
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 |
Practice improved Learned something Reminded something Confirmed Reassured |
Justify choice Understand issue |
No outcome |