Table 1

Avoidance of a Medical Test Associated With Found Information: A Clinical Vignette

MD08S03: Celiac disease
Bottom line: Information on celiac disease was used to justify the management of the patient (no testing), and it contributed to avoid an unnecessary diagnostic procedure.
Acquisition: On May 30, 2008 [quantitative data], MD08 did a search at work, with a patient, and during the encounter [qualitative data]. They retrieved one information hit about celiac disease: The reported search objectives were: to address a clinical question and to share the information with the patient [quantitative data]. “[I was] looking up the utility of doing the test in someone who did not have symptoms; […] a first degree relative [of the patient] had been diagnosed with celiac disease; […] [the patient] was asking some questions for herself, as to whether some of her symptoms from her gastrointestinal tract could have been caused by this [disease] […] and she was asking me about doing the testing. […] She was pretty much asymptomatic, but she had this family member, and she wanted to know whether she could have the same problem.[…]It wasn’t very clear whether people who had the specific test […], transaminase antibody, whether just having the positive antibody, without symptoms, whether those people would be considered a false positive, whether it really meant anything. […] She [the patient] had a question about it. I mean she was sharing information with me and I think was asking for my feedback” [qualitative data]. According to MD08, Essential Evidence Plus (EE+) was the only source of information, and the found information was relevant [qualitative data].
Cognition: One hit was associated with a report of highly positive cognitive impact (practice improvement) [quantitative data]. “I learned something about the sort of nuances interpreting these antibody results, […] knowing when to use it [the test] and also how to interpret the result. I think that was the [practice] improvement part of it” [qualitative data].
Retrieved information hit(s):
EBMG clinical topics: Celiac Disease (MD08S03H01) [quantitative data]
Application: Information on celiac disease was used for a patient [quantitative data] to justify their management (information used as presented in EE+) [qualitative data]. “It was basically to discuss the significance of her having a positive result, but not having symptoms; […] Just because you have a positive test doesn’t mean that you have the disease. That’s the message that I gave her.”
Patient outcomes: Regarding patient health, the information contributed to avoid an unnecessary diagnostic procedure. “[The information had an impact] in terms of not having to go into further testing” [qualitative data].