ABSTRACT
Importance: Women with interstitial cystitis/bladder pain syndrome (ICBPS) face isolation and treatment challenges. Group medical visits using Centering models have successfully treated other conditions but have not been explored in ICBPS. Objective(s): This study aimed to describe ICBPS pain and symptom control comparing standard treatment alone versus standard treatment augmented with Centering visits. Study Design: This prospective cohort study recruited women with ICBPS receiving standard care (control) or standard care augmented with group Centering. We administered validated questionnaires at baseline and monthly for 12 months. The primary outcome was change in the pain numerical rating scale, with Patient-Reported Outcomes Measurement Information System Pain Interference Scale and Bladder Pain/Interstitial Cystitis Symptom Score change as secondary measures. Result(s): We enrolled 45 women (20 Centering, 25 controls). Centering had significantly better numerical rating scale pain scores at 1 month (mean difference [diff], -3.45) and 2 months (mean diff, -3.58), better Patient-Reported Outcomes Measurement Information System Pain Interference Scale scores at 1 month (mean diff, -10.62) and 2 months (mean diff, -9.63), and better Bladder Pain/Interstitial Cystitis Symptom Score scores at 2 months (mean diff, -13.19), and 3 months (mean diff, -12.3) compared with controls. In modeling, treatment group (Centering or control) and educational levels were both associated with all the outcomes of interest. Beyond 6 months, there were too few participants for meaningful analyses. Conclusion(s): Women with ICBPS participating in a Centering group have, in the short term, less pain, pain interference, and ICBPS-specific symptoms than patients with usual care alone. Larger studies with more follow-up are needed to determine if this treatment effect extends over time.Copyright © 2022 American Urogynecologic Society. All rights reserved.
ABSTRACT
SETTING AND PARTICIPANTS: The COVID-19 pandemic has been associated with a rise of intimate partner violence (IPV) and increased use of televisits but there is no published curricula addressing IPV assessment and management in the primary care televisit setting. A novel and virtual 90-minute workshop was developed and delivered to small groups of internal medicine interns at an academic medical center. DESCRIPTION: The workshop consisted of a slide show reviewing IPV, audiovisual testimony of an IPV victim, fishbowl interview roleplaying, and a prerecorded session with our clinic social worker. The workshop answered five learning objectives that established a foundational knowledge of IPV, addressed specifically how it impacts our patient population, and presented tangible next steps to identify and manage IPV in the televisit ambulatory setting. EVALUATION: Interns' attitudes, beliefs, knowledge, and clinical interview practices were evaluated before and six weeks after the workshop with a voluntary two-section survey and virtual Objective Structured Clinical Examinations (OSCEs). First section reproduced a validated survey by Maiuro et al. with six categories: Blame, Inquiry, Role Resistance, Provider's Perceived Efficacy, System Support, and Victim/Provider Safety. Second section consisted of knowledge questions based on Insetta et al.'s shortened PREMIS survey. Statistical analysis was carried out with signed rank and McNemar's tests. Of the 40 interns who completed the workshop, 36 (90%) completed the pre-post survey. There were improvements in Provider's Perceived Efficacy, System Support, and IPV Inquiry categories. Learners had improved confidence in strategies to inquire about IPV (p <0.01), reported improved ability to provide resources (p <0.01) and make appropriate referrals (p <0.01), and increase in access to IPV management information (p <0.01). Learners felt social work or community advocates as well as mental health services were readily accessible (p <0.01). Post-workshop knowledge questions revealed an overall improvement (p <0.01). Most significant IPV knowledge improvements were in state- based reporting requirements and the effects of the COVID-19 pandemic on IPV incidence (p = 0.02, p = 0.05, respectively). Learners reported more frequent clinical practice inquiries about IPV in patients with chronic pelvic pain, headaches, and mood disorders (p = <0.01, 0.012, 0.014, respectively). DISCUSSION / REFLECTION / LESSONS LEARNED: A brief virtual and novel IPV curriculum increased resident knowledge of IPV and confidence in ability to identify, assess, and effectively manage IPV in televisits. It led to a reported increase in IPV inquiries in clinical practice. In combination, this readily transportable curriculum has potential for positively impacting the care of patients experiencing IPV. Next steps include analyzing our pre-post OSCEs to elucidate if IPV interviewing skills also improved.