P11S08: Restless legs syndrome (drug prescription)

Bottom line: Information on restless legs syndrome was used to maintain the management plan (starting medication), and to persuade the patient to make this change. There were no information-related patient health outcomes.

Level 1 outcome (situational relevance): On October 14, 2008, P11 did a search at work, by themselves, and before an encounter with a patient. They retrieved one information hit about restless legs syndrome. The reported search objectives were: to address a clinical question, and to share information with a patient or caregiver. “[The patient was] a woman approximately 60. [...] So the doctor called in a prescription for Sinemet. And the directions were “take one at bedtime for restless leg”. […][I had recently received on email a] highlight [about restless legs syndrome]. […]I knew there was an issue. I wasn’t a hundred percent positive that I remembered what it was. So I went looking for the highlight. […] What I wanted to know… First of all, what it was about the restless leg that that highlight had been about. I thought it was iron deficiency but I couldn’t remember for sure. And then, the second thing I wanted to know was had the patient had their iron tested prior to using Sinemet. […] I phoned the patient to inquire as to whether she had had her iron checked to make sure that her iron was adequate before we proceed with pharmacological therapy.” 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 practice improvement, P11 stated: “I know Sinemet is used for restless leg, and in the past, prior to having seen that, I would have just filled the restless leg and counselled the patient. But now, I have an added benefit of knowing that we should […] check for iron deficiency and so, that I should follow that up with either the patient or the physician prior to starting pharmacological therapy.”

Retrieved information hit:

1) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: Levodopa – Restless legs syndrome - Highlight (P11S08H01).

Level 3 outcome (information use): Information on restless legs syndrome was retrieved, and used to better understand a specific issue with respect to the management of the patient, to maintain (be more certain about) the management plan (starting medication), and to persuade the patient to make this change. “I called the patient and inquired whether she had had any blood test and the patient was significantly self-aware of her own medication or her own medical history management. She was aware that she had had blood test and actually, interestingly enough, the physician had also just become aware of this and he had talked to her about it and she had had her iron tested and it was normal. […] Now, she’s taking Sinemet for restless leg and it is helping. […] The patient was reluctant to start the Sinemet, actually. So in the course of the discussion, I was able to reassure her that the physician had followed the appropriate things and that certainly, Sinemet had been a good choice in the past for other people and because the physician had done a good work up, looked into the iron and the other potential causes, that realistically, this was a good choice moving forward.”

Level 4 outcome (patient health): Regarding patient health, P11 did not associate the information with any health outcomes.

Levels of outcome of information-seeking

Situational relevance	Positive cognitive impact	Information use	Patient health
Address a clinical question Share information	Practice improved Reminded something	Persuade Be more certain Understand issue	No outcome

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