P11S07: Anxiety disorders
Bottom line:
Information on anti-anxiety medication was used
to maintain the management plan (change patient medication to a drug covered by
health insurance), and to persuade other
health professionals to make this change. It contributed to increase patient satisfaction.
Level 1 outcome (situational relevance): On November 3, 2008, P11 did a search at work, by themselves, and
after an encounter with a patient. They retrieved one information hit about
anxiety disorders. The reported search objectives were: to address a clinical
question, to share information with a patient or caregiver, to exchange
information with other health professionals and to plan, manage, delegate or monitor tasks with other health
professionals. “The patient [a 55 year old woman] sees a
psychiatrist in her family doctor’s office once per month. She’s coping with
insomnia, depression and anxiety. She’s not satisfied with the level of
treatment that she’s receiving and is looking for an alternative. She finds her
anxiety level to be unacceptable. She [the patient] doesn’t want to use a Benzodiazepine and [...] the doctor had been discussing several
antidepressant options that have anti-anxiety effects. The patient, actually,
was concerned that the doctor would prescribe something that wouldn’t be
covered on the Ontario plan. [...] She [the patient] wanted me to provide the doctor with a list
of what was covered in advance of her next appointment. [...][I made the search and] the information was
jointly shared with the patient and the physician. [...]You know, this is a most interesting story
because, I provided the physician with the information and the physician had
the information, chose to ignore it anyways and gave the patient a prescription
for something that was not covered.
[...] she [the patient] said “I can’t afford
that. I told her I can’t afford it”. [...] So, then, I had to go back
and phone the physician and point out the Table. [...] So ultimately, [the physician] had to refer back to the chart and actually
pick a different drug but initially, my information was ignored.” According to P11, 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 confirmation and reminder, P11
stated: “[This
information confirmed I am doing the right thing] because I am
trying to manage the patient effectively and what’s covered for them. [...] This table didn’t
give me the information about what was covered but it gave me an easy chart to
refer to that I could use to organize my own thoughts, to remind me of what was
available and then, I could sort them according to covered or not covered.”
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): Therapeutics tab – Keyword: Anti-anxiety – Psychiatric disorders – Anxiety disorders – Pharmacologic choices – Table 3 – Printable table (P11S07H01)
Level 3 outcome
(information use): Information on anti-anxiety medication was retrieved, and used to better
understand a specific issue with respect to the management of the patient, to maintain the management plan (change patient medication to a drug
covered by health insurance), and to persuade other health professionals to
make this change (information from e-Therapeutics+ was modified). “[The found information was] modified,
because I added what was covered and what wasn’t. [...] I spoke to the family
doctor and I said “you know, this isn’t very helpful to your patient because
she now has no medication”. [...] In the end but it was the family doctor who
communicated the decision to me about what drug they would be using. [Did the
physician change to a covered one?] Yes. [Then, the patient came back to you?]
With other [covered] prescription. [...] We [the pharmacist and the patient] needed this information in
order to get them [the family doctor and the psychiatrist] to move forward with something that was going to meet the patient’s
needs financially.”
Level 4 outcome (patient health): Regarding patient health, P11 reported that the information
contributed to increase patient satisfaction. “[...] Her [the patient’s] anxiety had impacted her quality of life. We
[the 3 health professionals involved] needed to change the management [...] so she [the patient] could afford it [...] [and make] her daily living is better.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information Exchange information Manage patient care |
Reminded something Confirmed |
Persuade Be more certain Understand issue |
Patient satisfaction |