Patient-physician interaction kit beats drugs for IBS.(Clinical Rounds)

LOS ANGELES -- An educational tool kit designed to improve patient-physician interactions during visits for irritable bowel syndrome had a greater impact on global symptom relief than did any medication ever studied for the enigmatic disorder.

Dr. Brennan M. Spiegel and associates at the University of California, Los Angeles, tested the tool kit in a randomized study of 73 patients with irritable bowel syndrome (IBS) symptoms who attended the gastrointestinal disease catchment clinic for the VA Greater Los Angeles Health Care System. Follow-up surveys 3 months later found that patients assigned to the physician-patient intervention group were far more likely than were those who received standard care to say they had achieved relief of their global symptoms (20 of 36 patients, or 56%, compared with 5 of 34 patients, or 15%.)

The intervention effect size of 0.75 "exceeds the largest effect size demonstrated in pharmaceutical studies for IBS," Dr. Spiegel said at the annual Digestive Disease Week. For example, studies of alosetron using similar outcome measures had effect sizes between 0.2 and 0.5, he said.

"This does not mean by any means that these agents are not effective. It does suggest that medical therapy alone may be suboptimal if it is not delivered in the context of a supportive and informative physician-patient interaction," he said.

The multifactorial intervention consisted of a five-part tool kit that included:

* A waiting room questionnaire to document the patient's primary concerns, fears, and opinions about what might be causing IBS symptoms.

* A laminated flash card for the physician that includes key components of an effective discussion of IBS, including reminders to ask about psychosocial elements of the disease, descriptions of IBS in lay language, and the fact that IBS is not a life-threatening disease.