eP322 - Inception of a Pelvic Floor Practice in an Urban County Hospital

Purpose/Background: There are significant barriers to identifying, diagnosing, and treating patients with pelvic floor diseases (PFDs). PFDs are often underdiagnosed due to patient’s embarrassment about discussing the issue, and practitioners not initiating conversation about symptoms or knowing available resources. Limited resources at county hospitals impact the care provided to vulnerable and underserved populations experiencing PFD. To address issues of access and quality care at an urban county hospital, the first pelvic floor surgical practice was started by a colorectal surgeon in 2018. The hospital serves the most racially diverse patient population in the state. It is critical to better understand the patient population and determine institutional and patient barriers surrounding pelvic floor care at an urban county hospital in order to develop effective interventions.Methods/Interventions: A review of the electronic medical record was performed in September 2023 to understand the demographic characteristics of the patients served in the clinic since 2018. Through internal discussion, institutional barriers and limitations were identified by members of the pelvic floor clinic faculty and staff.Results/Outcomes: The pelvic floor clinic has provided care to 68 patients (see Table 1). The diagnostic groupings included fecal incontinence (17.6%), pelvic floor (64.9%), and rectal prolapse (17.6%). While most patients are female, males make up 30.9% of the population. The majority were African American (36.8%) and Hispanic (41.1%) and identified their preferred language as English (55.9%) or Spanish (39.7%). Most were uninsured (44.1%) or had Medicaid (29.4%). The top three discharge zip codes for patients at the hospital are predominantly African American (83.8%), have an education level of high school or less (78.2%), and are unemployed (52%). The team identified diagnostic equipment (anorectal manometry, biofeedback software, and anorectal high-quality ultrasound) and treatment options (injectables or sacral nerve stimulation (SNS) for fecal incontinence, trained biofeedback therapists) that were not available at the county hospital. Current, treatment options through the clinic only ameliorate symptoms and do not treat the underlying causes.Conclusion/

Discussion: The initial query revealed the pelvic floor surgical practice provides necessary care for many underserved and vulnerable patients. Improving the diagnosis and treatment of patients with PFDs requires a multi-pronged approach – increasing institutional resources including diagnosis and treatment options, working with primary care providers (PCP), and addressing individual barriers. The colorectal surgeon’s advocacy for improved care resulted in acquiring additional resources. Anorectal manometry is moving forward for approval and by the end of 2023 the first two SNS cases are expected to be completed. To increase clinic volume, a system is being designed by a colorectal fellow to provide education to PCPs about the resources now available at the clinic. Future studies include, clinic referral practices; determining correlations between patient outcomes and patient education, patient characteristics, social determinants of health, and individual barriers. The outcome of this multi-pronged approach will provide further insight into barriers to pelvic floor care at a large county hospital and encourage engagement of community practitioners and their patients in the treatment of pelvic floor diseases.Demographics