P12S10: Irritable bowel syndrome

Bottom line: Information on Irritable bowel syndrome was used to maintain the management plan (stop medication outside acute symptoms), and to persuade the patient to make this change. There were no information-related patient health outcomes.

Level 1 outcome (situational relevance): On October 6, 2008, P12 did a search at work, by themselves, and after an encounter with a patient. They retrieved two information hits about Irritable bowel syndrome. The reported search objective was: to address a clinical question. “[The patient was] a female in her fifties. [...] The doctor prescribed the Dicetel which did actually help with her symptoms. And then, she [the patient] was kind of saying to me, well is this something that I have to continue to take or is it something that I only take when I kind of need it. So, I went to get this information to be able to give it to her, to kind of help her to better understand what she needed to do. [My clinical question was also] […] the dosing and effectiveness of Dicetel in treating women with Irritable bowel syndrome.” According to P12, the information from e-Therapeutics+ was more relevant as the information from another paper-based resource (Pharmacist letter). “I probably checked Pharmacist letter.”

Level 2 outcome (cognitive impact): The first hit was associated with a report of positive cognitive impact (see table). Regarding confirmation, reassurance, and reminder, P12 stated: “I was pretty sure that Dicetel could be used for Irritable bowel syndrome which is why I had actually recommended it in the first place. […] I thought I sort of knew the information and because I’d actually been involved in making the recommendation to start the Dicetel, it was kind of nice to know that it actually helped her [the patient].”

Retrieved information hits:

1) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: IBS – Pharmacologic choices – Paragraph under Pharmacologic Choices (for P12) (P12S10H01)

2) e-Therapeutics+ (CIRT): Therapeutics Tab – Keyword: IBS – Pharmacologic choices – Print whole page (for patient) (P12S10H02)

Level 3 outcome (information use): Information on Irritable bowel syndrome and Dicetel 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 (stop medication outside acute symptoms), and to persuade the patient to make this change (information used as presented in e-Therapeutics+). “I just gave her [the patient] the information. [...] I wanted her [the patient] to sort of see the non drug thing so she could be doing as well, to sort of help more self-manage her problem, than just relying on the drug. [The information was retrieved] […] to help her to better understand the underlying ideology of the disease, […] and then persuade her to sort of maybe make some changes in her non drug management or her diet. [...] She had actually stopped the Dicetel. [...] So I was sort of suggesting what she should be doing.”

Level 4 outcome (patient health): Without this information hit, P12’s management of the patient would have been the same. There was no clear relationship between the information use and patient health outcomes.

Levels of outcome of information-seeking

Situational relevance	Positive cognitive impact	Information use	Patient health
Address a clinical question	Reminded something Confirmed Reassured	Persuade Be more certain Understand issue	No outcome

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