The Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation (FMD RapSDI) program empowers doctors to research and scale great ideas, quickly. As a collaboration between the AAFP Foundation and the AAFP National Research Network, FMD RapSDI is open to practicing physicians with little or no research experience.
Every year, two select FMD RapSDI Scholars receive up to $40,000 to create new evidence for “what works” in real-world primary care settings. We’re pleased to announce that the 2022 RapSDI Scholars are Michael Arnold, MD, FAAFP, and Allene Whitney, MD.
Uniformed Services University of the Health Sciences in Bethesda, Md.
Study/Project Title: Patient-Applied Pre-Procedural Analgesia for Intrauterine Device Placement (PAP AID)
Arnold’s research study expands his work to make IUD insertions less uncomfortable for patients, and he shares credit for the research concept with the women in his family.
“When it’s time for an IUD insertion, patients often grit their teeth and say, ‘Let’s get this over with,’” Arnold says. “I talked it over with my wife and said that one thing we can do is insert topical lidocaine beforehand, but it takes a long time to get the numbing effect – it would be better if patients could do it before the appointment. My wife said, ‘Why not use a tampon to put the medicine on and insert it that way?’”
After gathering additional insight from his daughter, Arnold moved forward with the idea on a small scale in his office.
“I’ve now taken this approach with 10-15 of my patients. They insert the tampon with lidocaine 30 minutes prior to the procedure, and reports of pain are much less.”
For the larger research study funded by FMD RapSDI, Arnold says half of the participants will receive topical lidocaine and the other necessary materials in a test kit; the other half will receive the same kit but with surgical lubricant included, rather than lidocaine. Results will be gathered using three measurements: 1-10 pain scale for patients to rate their pain overall; the time it takes to perform the procedure; and provider-rated difficulty.
To reach a broad base of patients, Arnold plans to partner with family medicine residency programs at local hospitals; much of his FMD RapSDI funding will go toward hiring a research coordinator.
“Assuming this proves successful, and the evidence is very important, this would be something we’d like to see implemented broadly,” Arnold says. “This is not a money maker – topical lidocaine and tampons are widely available. But it could be an easy, immediate fix if the evidence shows that it’s beneficial.”
Providence Family Medicine Residency, Anchorage, Alaska
Study/Project Title: Use of Virtual Visits to Enhance Prenatal Care Among Individuals with Substance Use
The confluence of the pandemic and the start of the Alaskan Addiction Medicine Fellowship sparked the idea for Whitney’s project: Could virtual visits, proven effective during the pandemic, help pregnant patients with substance use disorders?
The importance of prenatal visits is well documented: Whitney says the World Health Organization has noted adverse outcomes when a patient receives fewer than four prenatal visits. Substance use – a significant issue in Alaska and throughout the U.S. – can contribute to missed appointments.
“There’s a stigma associated with substance use, especially with pregnant people and patients may fear acknowledging the issue,” Whitney says. “We will be recruiting patients who are struggling to get to their prenatal visits. Many of these patients are dealing with more than medical issues. What barriers do they feel they face when engaging in prenatal care? It could be the health care system. It could be worrying about the legal system. The barriers could be as simple as transportation.
“We’ll ask if the video visits are helpful and how. We’d really like to hear their voices.”
The initial stage of the research project is underway – community outreach with health care partners, such as local hospital emergency rooms.
“Once patients are identified and interested in the study, we’ll offer them information,” Whitney says. “They would establish prenatal care with an in-person visit, a physical exam, and a psycho-social intake to identify barriers to care, etc. Then, we’ll establish the prenatal medical care plan going forward and incorporate video visits on days when they miss a visit.
“My hope is that our clinic and health care will become more insightful about the needs of people with substance use disorders during and beyond pregnancy and become more adaptable to those needs. We want to support our patients to improve their health and the health of their babies.”