P11S02: Urinary
incontinence (drug-induced)
Bottom line: Information on urinary incontinence was used to justify the management of the patient and
to persuade the patient and other health professionals to make a change (discontinue medication causing incontinence). It contributed to
increase patient knowledge, avoid an inappropriate diagnostic procedure and
improve patient health.
Level 1 outcome (situational relevance): On June 10, 2008, P11 did a search at work, by themselves, and after
an encounter with a patient. They retrieved one
information hit about urinary incontinence. The reported search objective was: to address a clinical question. “She [the patient, a 55 year old woman] has got sort of a complicated history surrounding this urinary incontinence.
And I was looking for general information. She [the patient] has had a huge work up by physicians…two specialists…and she's still
suffering from urinary incontinence… [...]...the bottom line was: the urinary
incontinence was drug-induced. [...] We wanted to discontinue
the medication (Trazodone) that was causing the problem…We wanted to start one
that would help, as well as address the issue that the original prescription
wasn't. So I was looking for an option. [...] I was
looking for a tricyclic antidepressant [...] to specifically try and find which
one would be the most appropriate.” According to P11, the information from e-Therapeutics+ was in agreement
with and equally relevant as the information from a paper-based resource (CPS
paper version) and another pharmacist. “I think I was just looking for dose [in the CPS] [...] and I'm sure I could have
found it in e-Therapeutics too, but it's just faster with the book.”
Level 2 outcome (cognitive impact): One hit was associated with a report of positive
cognitive impact (see table). Regarding practice improvement, P11
stated: “I had found that the side effects of trazodone was
causing this patient's problem [....]. I will be more cautious
about using Trazodone in patients who already have incontinence.”
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): Therapeutics tab – Keyword: Incontinence – Urinary
incontinence in adults – Stress incontinence – Drug therapy for stress
incontinence: Table 3 (Table 3 was the
evaluated information, not the highlight) (P11S02H01)
Level 3 outcome
(information use): Information on urinary incontinence was retrieved,
and used to justify the management of the patient, and to persuade the patient
and another health professional to make a change (information from
e-Therapeutics+ was modified to fit the specific clinical history of the
patient). “The tricyclic recommended was Imipramine, [but] after speaking with the patient, who also has
suffered from depression, we discovered that Imipramine was not the best drug
for her. She had tried it in the past, and it had not helped her sleep and
depression. So we used a different tricyclic that wasn’t recommended in the
table but that [...] I also found was useful
for incontinence [in other sources], [...] and had a more sedating effect and a heavier
antidepressant effect. [...]I used the information in
e-Therapeutics as a springboard to modify drug treatment for the individual
patient. [...]I
discussed the options for change with the patient quite thoroughly, and she was
definitely on board… and then I got her permission to advise her physician. So, I did. I documented all of the research
I had done and sent him a letter. And later that afternoon, he changed her
therapy to my recommendation. ”
Level 4 outcome (patient health): Regarding patient health, P11 reported that the information
contributed to increase patient knowledge, to avoid inappropriate use of a
medication and further diagnostic procedure, and to improve patient health. “This patient has had a phenomenal amount of
work up surrounding her urinary incontinence, and told that there was nothing
wrong with her. After the research I did, I found that she was suffering a drug
side effect, so that was a huge knowledge for her. It really
[led the patient feel] "I'm not going crazy"!. [...][This also means] no more urogenital workups for this poor woman. [...] I actually checked [improve patient health] at the time that I rated
it, but that was a hypothetical answer. I went on vacation and I called her [the patient] to follow up when I got home, and she’s in
7th Heaven! "I haven’t peed the bed for months" [said the patient] [...] It was a wonderful success story, believe me. [...] I think another outcome was that I built a
solid rapport with the physician, over my own ability to solve problems. ”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question |
Practice improved Learned something |
Persuade Justify choice |
Improve Avoid Patient knowledge |