June 16, 2022, 11:54 a.m. Michael Devitt — Three years ago, the AAFP Foundation and the AAFP National Research Network joined forces to establish the Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation initiative. The program’s main objective is to recruit family physicians who want to learn about and perform clinical research but are unable to develop their ideas due to a lack of time or funding. It provides its awardees with the resources and support to help them complete their projects. Findings from these projects serve as part of an overarching goal to find meaningful solutions to real-world clinical questions that family physicians and other clinicians encounter in primary care.
Since the first group of RapSDI scholars was announced, in May 2020, family physicians have conducted research on a wide range of topics frequently seen in practice, including intimate partner violence, medically tailored meal kits, acupuncture for chronic pain management and addressing gun violence. That practice will continue with this year’s scholars, both of whom were selected after an extensive application and review process, and both of whose projects will focus on women’s health.
Allene Whitney, M.D., M.S., a core faculty member and OB/newborn curriculum lead at the Alaska Family Medicine Residency Program in Anchorage, will examine methods that combine traditional visits with telehealth strategies to increase and improve prenatal care among pregnant women facing socioeconomic challenges, in particular those experiencing substance use disorders.
Whitney explained in an email to AAFP News that she has long been interested in incorporating research into her career, and that the RapSDI initiative provided her with an ideal opportunity to pursue that interest. Whitney said the idea for her project, “Use of Virtual Visits to Enhance Prenatal Care Among Individuals With Substance Use,” resulted from changes to the delivery of prenatal care that she experienced during the COVID-19 pandemic.
“Pregnant individuals with substance use disorders often obtain little or no prenatal care, putting them at risk of adverse outcomes,” Whitney said. “While multifactorial, this problem may be exacerbated by both a lack of outreach and a rigid prenatal care system that does not tolerate missed appointments.
“The COVID-19 pandemic forced us to think of prenatal care delivery in a new way,” she added. “Although we would not in the past have thought of video visits as a viable option for prenatal care, the need to reduce viral exposure early in the pandemic caused us to generate a new schedule of visits, with key in-person visits supplemented with intermittent video visits. I would like to look at how such telehealth visits can be leveraged to supplement prenatal care in the future for those who struggle to successfully attend in-person visits.”
Whitney’s overall goal is to create a less rigid model of prenatal care that can be shared and duplicated by family physicians throughout the country.
“For patients facing socioeconomic barriers, current systems of prenatal care can create a contentious and punitive environment; patients who ‘no-show’ a certain number of appointments may be ‘fired’ from care,” Whitney noted. “This system contributes to health care disparities in the United States, restricting care among those who need it most. A more flexible system may offer a remedy and help individuals stay engaged in care throughout pregnancy.”
Whitney added that the results of her research could provide further benefits by making clinicians more aware of the challenges some pregnant patients face.
“I hope that the process of making prenatal health care delivery more flexible will also make us more introspective toward individuals who are pregnant and experiencing substance use disorders or other socioeconomic barriers,” she said. “Research is an avenue not only to generate data, but to gain insight. This project will document how patients utilize virtual visits and also ask participants for their perspectives as to what other innovations in care might be most useful for them.
“Ultimately, I hope that this project contributes to more effective prenatal care, for the health of parents and babies.”
Capt. Michael Arnold, M.D., an associate professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine in Bethesda, Md., credits a conversation with his wife and adult daughter as the inspiration for his project.
“While talking about a day in clinic, I mentioned that a lot of women avoided IUDs because of the discomfort,” Arnold said. “I mentioned that some studies that involved painting the cervix with numbing medication showed benefit, but you had to wait for the medication to work. My wife asked why the medication wasn’t just applied with a tampon, which my adult daughter thought would be easy.
“I offered this procedure to medical students, who I expected would be open to the idea. I prescribed them viscous lidocaine to put on the deep side of a tampon, apply 30 minutes before the procedure and remove when changing for the procedure. I was surprised that it seemed so much better, with patients asking, ‘Is it already over?’ instead of showing signs of discomfort I was more used to seeing. I also noticed that the procedures were faster and easier to perform.”
Arnold decided to use the findings from these patient experiences as the basis for a formal research project, “Patient Applied Pre-treatment Anesthesia for Intrauterine Device Placement (PAP AID).”
“My research will be looking at the benefit from women applying topical anesthetic to the cervix using a tampon 30 minutes prior to an IUD insertion procedure,” said Arnold. “We’re going to compare patient perception and procedure time between topical lidocaine and placebo applied by the patient.
“If we find this intervention is clearly beneficial, it will be easy to implement. There is no proprietary technology, just the topical lidocaine we use for numbing mucosa like in the mouth.”
According to Arnold, IUDs are the most commonly used form of long-acting reversible contraception, and while LARCs are considered 20 times more effective than birth control pills, some women may avoid getting an IUD because of the discomfort associated with placement.
Arnold said that the procedure could be of particular benefit to women serving in the armed forces and could also prove useful for other types of procedures.
“For military servicewomen, the convenience of a birth control method that can last up to 7 to 12 years can be helpful as they look to deployments and going to sea or the field frequently,” Arnold noted. “Some IUDs can also help with heavy or painful periods. Obviously, these benefits are important to many women who aren’t in the military as well.
“This is also something that can be used for other pelvic exams and procedures,” he added. “We perform procedures that sample the cervix or uterine lining when we are concerned about cancer, and those are procedures that could use pain reduction, too. Adolescents or women who experience pain during pelvic exams could also benefit when these exams are required.”
Arnold noted that he plans to conduct the project at a number of family medicine residency programs, which would give residents the opportunity to participate in clinical research — and possibly spur some of them to pursue their own research interests in the future.
“I wouldn’t be surprised if you saw a few future RapSDI applicants from that group,” he said.
Each scholar will receive a $40,000 grant to help mitigate project-associated costs and/or offset the time and salary needed to develop and complete their projects. Both scholars also will receive support and mentorship from NRN staff to refine research protocols, perform related project activities and analyze study data.
Projects are expected to be completed within 12 months. After completing their research, scholars will have the opportunity to participate in one or more research conferences and to author a manuscript in a peer-reviewed journal.
For AAFP members interested in becoming FMD RapSDI scholars, the 2023 application period will open July 1. Members must be practicing FPs in any post-residency stage of their career to apply. Potential applicants are encouraged to bookmark the FMD RapSDI webpage and visit it frequently for periodic updates on the application process.