Abstracts from the 2020 Annual Meeting of the Society of General Internal Medicine

s from the 2020 Annual Meeting of the Society of General Internal Medicine "J OURNEY OF A THOUSAND MILES” CHALLENGES ENCOUNTERED BY INTERNATIONAL MEDICAL GRADUATES AND COMPARATIVE PROBLEMS FACED BY AMERICAN GRADUATES DURING INTERNAL MEDICINE RESIDENCY TRAINING AT A COMMUNITY HOSPITAL IN ILLINOIS. Gauri Pethe. Internal Medicine, Amita Saint Francis Hospital, Evanston, IL. (Control ID #3392714) BACKGROUND: International physicians make up 25% of the physician work force in the United States, a majority of international applicants pursue Internal Medicine. Based on their accents, religious symbolism or ethnicity, they are often perceived as being different. AmericanGraduates, although being in a familiar environment, face huddles such as student-loan debt and face challenges such as having to compete with International-Graduates who have more clinical experience. METHODS: A cross sectional study was done at Saint Francis Hospital. Questionnaires included a basic survey about questions including wellness, personal and work life balance, burnout, and discrimination at the workplace. International students had additional questions including ease of availability and access to basic necessities such as housing, cultural food, and community and learning curve. Questions also included communication barriers faced, and other perceived challenges. American Graduates were inquired about challenges and their perception regarding integration of international students. RESULTS: Total residents were 60; 39-IMGs-65%, 2-US-IMGs 3.33%, 19-AMG-31.66% with 22IMGs-56.4% and 10-AMGs-52.63% replied. Within IMGs: 12-females(54.54%) and 10-males(45.45%). AMGs: there were 5 females(50%) and 5 males(50%). 100%-IMGs applied for US residency match for: Better opportunities, 36.36%-Better pay, 90.9%Quality of life, 86.36%-Work hours. 95.45%-IMGs reported better work hours. 31.81%-IMGs stayed late for work vs 20%-AMGs. 22.73%-IMGs had difficulty finding apartment vs 0%-AMGs. 68.19%-IMGs reported difficulty in finding local food, 77.28%-reported difficulty finding home community. 90.9%-IMGs feel compensated enough for the work they do vs 60%-AMGs. 27.27%-IMGs face discrimination; 83.33%were discriminated based on race vs 30%-AMGs; 66.66% was racial and 33.33% sexual. 45.45%-IMGs reported depression vs 60% AMGs. 80% IMG and 83.33% AMGs are likely to seek help, mostly from family. Both IMGs and AMGs reported to feel burned out at least once a month, most during long-call days. 63.63%-IMGs reported ease in balancing work/personal life vs 80%AMGs. Most IMGs and AMGs interact with each other during work, and have no problems making friendsips, but rarely meet socially. 36.36%-IMGs think they are treated differently than AMGs. Biggest challenge for IMGs when adjusting to the US system was cultural change and getting used to EMRs. 81.81%IMGs and 90%AMGs stated that this is their intended specialty. Most IMGs are able to visit home 1-2 time/year, 4 cannot due to civil war. 100% IMGs do not regret their decision to pursue residency in USA. CONCLUSIONS: This study outlines different difficulties faced by IMGs and AMGs alike. IMGs reported more racial discrimination and the biggest challenge was to learn the Electronic-Medical-Records and culture. Despite these challenges, IMGs reported that 100% of them do not regret their decision to pursue residency in the United States. A MULTI-SITE FOCUS GROUP STUDY OF U.S. ADULT WOMEN’S BELIEFS AND ASSUMPTIONS ABOUT BLADDER HEALTH AND FUNCTION Beverly R. Williams; Missy D. Lavender; Kathryn L. Burgio; Yvette LaCoursiere; Diane K. Newman; Sonya S. Brady; Lisa K. Low; Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consoritum. Medicine, University of Alabama at Birmingham, Birmingham, AL; Medicine, Birmingham/Atlanta GRECC, Birmingham VA Medical Center, Birmingham, AL; Independent Researcher, Chicago, IL; Obstetrics, Gynecology, and Reproductive Health, UC San Diego Health La Jolla, La Jolla, CA; Medicine, University of Pennsylvania, Philadelphia, PA; School of Public Health, University of Minnesota, Minneapolis, MN; School of Nursing, University of Michigan, Ann Arbor, MI; NIH-NIDDK, District of Columbia, DC. (Control ID #3360438) BACKGROUND: The Study of Habits, Attitudes, Realities, and Experiences (SHARE), a qualitative study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, explored women’s knowledge experiences, perceptions, knowledge, and behaviors about bladder health/function. The purpose of this analysis was to characterize women's lay beliefs and assumptions about bladder health and function. METHODS: Forty-four focus groups were conducted across seven U.S. research centers with 360 women and adolescents, organized by six age categories. Focus groups were audio-recorded and transcribed. Following transcript and fieldnote coding, multi-level qualitative content analyses was used to classify emergent themes. A transdisciplinary lens and inductive approach guided data interpretation of the” bladder beliefs and assumptions code”. A team of investigators articulated interpretive insights, which were validated by a community engagement panel. RESULTS: Women exhibited limited understanding of bladder health and function, with assumptions and beliefs shaped by personal experience and hearsay. Except for the rare occasion when women had input from a medical professional, notions about bladder health and function were characterized by uncertainty, tentativeness, and unconfirmed impressions. Women speculated on (1)the function of the urinary tract system in cleansing or flushing the bodily system of impurities and toxins, (2) the functional relationship between and among the kidneys, bladder, urethra, vagina, pelvic floor and (3)the impact on bladder function of medications for chronic conditions. Women’s assumptions and beliefs about bladder healthwere framedwithin a “cause and effect” perspective, covering a wide array of habits/behaviors while conjecturing about the physiological mechanisms through such practices promote or deter bladder health. Finally, there was agreement on the importance of bladder friendly habits and the inadvisability of potentially harmful practices. This was acompanied by an assumption that bladder problems could be prevented by developing communitybased programs for educating women about bladder health and function, encouraging women to practice healthy bladder habits, eliminating taboos about discussing bladder health, and empowering women to speak out about their bladder-related experiences and concerns. S1 DOI: 10.1007/s11606-020-05890-3 © Society of General Internal Medicine 2020 J Gen Intern Med 35 :S1–S779 (Suppl 1) 8 Published online July 2 , 2020 CONCLUSIONS: Community-engaged public health messaging can inform women’s assumptions and beliefs about bladder health/function, educating women about the promotion of bladder health and the prevention of LUTS. BEHAVIORAL INCENTIVES TO IMPROVE MOBILITY AND DECREASE OPIOID USE IN VETERANS WITH CHRONIC PAIN Manik Chhabra; Krisda Chaiyachati; Peggy Compton. School of Nursing, University of Pennsylvania, Philadelphia, PA; Corporal Michael Crescenz VA Medical Center, Philadelphia, PA; University of Pennsylvania, Philadelphia, PA. (Control ID #3389698) BACKGROUND: An estimated 88.5 million adults suffer from daily pain, resulting in an estimated cost of $635 billion in lost productivity and $300 billion in health care expenditures. To manage their chronic pain, 5 to 8 million Americans take an opioid medication daily. However, the risks associated with ongoing opioid use (overdose, abuse, diversion) temper their analgesic effects. Appreciating the gains in health outcomes that behavioral incentives produce, we tested the hypothesis that loss-framed financial incentives combined with technology enabled care (TEC) can improve patient mobility, reduce pain, and decrease opioid use in patients with chronic pain. METHODS: We conducted a randomized controlled trial, allocating 40 patients 1:1 to a lottery-based behavioral incentive program combined with TEC vs. TEC alone (e.g., text-message communication and activity trackers). Patients were eligible if they received care from a VA pain-focused primary care program, on opioid therapy, and had a cell phone with text messaging capabilities. Patients were excluded if they had cancer-related pain, sensory impairments precluding the use of TEC, or had mobility limitations precluding them from walking. The primary outcome was the change in mobility (number of steps taken), and secondarily, pain severity, physical function, and opioid use using self-reported questionnaires over 12-weeks. Data were collected weekly using activity trackers, and text-messaged questionnaires. We measured baseline mobility using a two-week pre-study period observation before randomization. For the lottery + TEC arm, participants were eligible for a weekly regret lottery if their steps increased by 5% from the prior week. Once the subject reached 150% of baseline, they were always entered into the lottery. The eligible lottery participants could win either $30 or $100; those not meeting the walking goals were told what they would have won had they met their goal. RESULTS: Forty subjects have been enrolled and 38 have completed the study. The remaining two subjects will complete the trial by January 31, 2020. The results of the full sample will be available for presentation. Based on interim data analyses on the first 20 subjects, the lottery + TEC arm increased weekly average by 2004 steps, whereas the TEC only arm decreased by 1239 steps. For secondary outcomes, the lottery + TEC arm had improvements in pain severity and physical function but not chronic pain. CONCLUSIONS: Combining a regret lottery incentive with TEC improved mobility in patients with chronic pain, as well as increased participation in exercise and decreased pain severity and interference. While additional interventions o