P06S06: Peptic ulcer
Bottom line: Information on Helicobacter
pylori eradication was used to maintain the management of the patient with
peptic ulcer (medication). There were no information-related patient health
outcomes.
Level 1 outcome (situational relevance): On December 9,
2008, P06 did a search at work, by themselves, and before an encounter with a
patient. They retrieved one information hit about Helicobacter pylori
eradication. The reported search objectives were: To address a clinical
question and to look up something they forgot. “I knew about the treatment. [...] I was searching to see if... once
they did the eradication treatment, how long does he [the patient] need to stay
on a PPI [proton pump inhibitor], or should they just stop after the
eradication. [...] I was looking for something that would tell me, if my
patient still has symptoms after the eradication treatment, would it be
beneficial to stay on PPI? Or should I stop it, wait for two or three weeks,
and then restart it? […] I still don’t have my answer. […] [The patient was] a
young woman, approximately 22 years old [...], and she had quite a lot of
dyspepsia and some weight loss and a pretty significant anaemia. So I suspected
she had an ulcer, so I had started her on a PPI, and her H-pylori came back positive
so... Then I treated her, but I kept her on the PPI after, because I couldn’t
find my answer, if I should take her off or leave her on it. [...] It
[e-Therapeutics+] confirmed my ‘triple cocktail’ that I wanted to give to
eradicate H-pylori, but it didn’t give me the answer concerning “should I leave
her [on a PPI] after or not?” According to P06, the information from
e-Therapeutics+ was in agreement with and equally relevant as the information
from another health professional (physician), and from another paper-based
resource (Ontario Guidelines for peptic
ulcer management?).
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive
impact (see table). Regarding confirmation and reassurance, P06 stated: “It confirmed that I had
the right cocktail. […] [I was] reassured that I had the right medication.”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT):
Therapeutics tab – H-pylori - peptic ulcer disease – whole chapter (P06S06H01).
Level 3 outcome
(information use): Information on Helicobacter pylori
eradication was retrieved, and used to maintain (be more
certain about) the management of the patient (information used as presented in
e-Therapeutics+). “For her symptoms, [the
patient] was on the PPI for about four weeks after the treatment. [...] And
then, well I saw her again [...], she was much better. She doesn’t take her
medication anymore. So I think it went well. [...] I had the right cocktail.
And I didn’t change anything that I was about to give her.”
Level 4 outcome (patient health): Without this
information, P06’s management of the patient would have been the same. There
were no clear relationships between the use of information and expected patient
health outcomes.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten |
Confirmed Reassured |
Be more certain |
No outcome |