P09S01: Back pain
Bottom line:
Information on low back pain was used to modify the management of the patient,
and to persuade other
health professionals to make changes regarding the treatment for this patient who
cannot use non-steroidal anti-inflammatory drugs (NSAIDs). It contributed
to increase patient knowledge, and avoid an inappropriate treatment.
Level 1 outcome
(situational relevance): On August 1, 2008,
P09 did a search at work, by themselves, and after an encounter with a patient.
They retrieved one information hit about low back pain. The reported search
objectives were: to address a clinical question and to look up something they
forgot. “[The patient was a] male, forty five. [...] I was looking for options for management of back
pain. [...] And also the other reason I was looking is to look at other options
for treatment. [...] This patient had Crohn's disease and I wanted to see if
there was any problem with using NSAIDs. [...] The question was: what are the
options for treatment for back pain when dealing with Crohn's disease? [...]
Besides NSAIDs, that's what I was looking for, what are the, the topical
options? Are there other treatment options? [...] I knew, but I couldn't quite
remember what the range was.” According to P09,
the information from e-Therapeutics+ was in agreement with and equally relevant
as the information from Google and from a paper-based resource (RX files
textbook).
Level 2 outcome
(cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding practice
improvement, P09 stated: “I found an answer to my question in terms of options and not to use, I
think, specifically it was around Diclofenac, topical, whether it’s
systemically a problem for absorption. [...] If somebody's bleeding, [...] I
won’t be using it. I’d probably be using more the codeine options on these
particular patients [people with inflammatory bowel disease].”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT): Therapeutics tab – back pain – Chapter on low back pain (P09S01H01)
Level 3 outcome (information use): Information on
back pain was retrieved, and used to modify the
management of the patient, and to persuade other health professionals to
make changes (information used as presented in e-Therapeutics+). “We decided not
to treat it with a NSAID. [...] I took him off the Diclofenac. [...] And then I
went and discussed it at one of our team meetings.”
Level 4 outcome
(patient health): Regarding patient health, P09 reported
that the information contributed to increase patient knowledge, and avoid an
inappropriate treatment (topical NSAID). “I would
typically present what I’d found in my search, and so that patients are aware
that I’m up-to-date and also giving them the most up-to-date information. I
usually share the information with them so that they’re more confident with the
treatment. [...] By being informed about what are the options for treatment, what
is the best course, they’re much more likely to be accepting that something’s
going to be chronic, and accepting that they need to move.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten |
Practice improved Learned something Reminded something Confirmed Reassured |
Persuade Manage differently |
Avoid Patient knowledge |