Over-The-Counter Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu

Since the United States Food and Drug Administration’s approval of over-the-counter levonorgestrel emergency contraception, access to this time-sensitive medication has improved. However, multiple barriers, including the cost of the medication and pharmacy availability, still exist. The objective of this study was to determine the over-the-counter availability of levonorgestrel emergency contraception in pharmacies on Oahu, Hawaii. We conducted a cross-sectional population-based study using in-person simulated patient encounters at all pharmacies on Oahu. Out of 109 chain pharmacies and 13 independent pharmacies, 102 (84%) pharmacies had levonorgestrel emergency contraception available over the counter. Of pharmacies in which it was available, 12.7% required an employee to unlock the medication, 37.3% required the medication to be unlocked at the register, 29.4% were packaged in a large plastic box, and 3.9% were packaged in a blister pack. Levonorgestrel emergency contraception is widely available as an over-the-counter medication in pharmacies on Oahu, yet there are packaging and display practices that make it less accessible. Many of these practices could be improved with pharmacy education or changes in store policies. Systems-based interventions are needed to improve the access to levonorgestrel emergency contraception as an over-the-counter medication

Management of Early Stage, High-Risk Endometrial Carcinoma: Preoperative and Surgical Considerations

Endometrial cancer is the most common gynecologic malignancy in the developed world. Most cases are diagnosed at an early stage and have low-grade histology, portending an overall excellent prognosis. There exists a subgroup of patients with early, high-risk disease, whose management remains controversial, as current data is clouded by inclusion of early stage tumors with different high-risk features for recurrence, unstandardized protocols for surgical staging, and an evolving staging system by which we are grouping these patients. Here, we present preoperative and intraoperative considerations that should be taken into account when planning surgical management for this population of patients

Teledoulas: Medical Students' Experiences Providing Remote Support for Abortion Patients

Introduction: The number of trained abortion providers in the U.S. has been steadily declining even though 1 in 4 pregnancy-capable people will have an abortion in their lifetime [1, 2]. Nationwide surveys on abortion education in medical schools reveal that only 32% of schools provide lectures on abortion and only 45% of Ob/Gyn clerkships provide clinical exposure to abortion care [3, 4]. During the COVID-19 pandemic, there has been an increase in patients seeking medication abortions via telemedicine and a decrease in direct patient care opportunities for medical students [5]. The Doula Project is a program that provides JABSOM students with the opportunity to remotely serve as telemedicine doulas (teledoulas) for patients undergoing medication abortions in Hawaii. Objectives: The purpose of our study was to investigate medical students’ experiences volunteering as abortion teledoulas in providing emotional support, education, pain management, and self-advocacy via phone call and text messaging to patients throughout the medication abortion process. Methods: We designed online pre- and post-training surveys for JABSOM medical students undergoing training as teledoulas to assess the following: (1) clinical knowledge and attitudes towards abortion, (2) acquisition of skills including communication and patient advocacy, and (3) impact on professional goals pursuing fields in reproductive healthcare. We invited a total of 28 medical student teledoula volunteers (22 preclinical and 6 clinical across two training cohorts) to participate in our study. The first cohort of 10 teledoulas completed the post-training survey only. The second cohort completed both pre- and post-training surveys. This study was determined to be exempt by the University of Hawaii IRB. Results: Nine teledoulas (90.0%) from the first training cohort completed the post-training survey. Six of the 18 teledoulas (33.3%) from the second cohort completed both the pre- and post-training surveys. All self-identified as “pro-choice.” Prior to training, 93.3% had not had clinical exposure to abortion care. After training, most felt more capable of advocating for their patients (73.3%) and answering questions regarding the medication abortion procedure (86.7%), common complications (80.0%), and pain management options (93.3%) (Figure 1). Overall, most students reported a positive impact on their personal development (66.7%), emotional maturity (66.7%), and education (80.0%) (Figure 2). After participating in the program, 60% reported a greater inclination to pursue a career in women’s health or incorporate it into their career path and 80% reported that they intend to become abortion providers. When self-rating communication skills on a Likert scale, pre-training students reported a mean comfort level of 3.53/5 in discussing difficult topics with patients while post-training students reported a mean comfort level of 3.93/5 (p-value = 0.14; NS) (Figure 3). Discussion: Medical students volunteering as teledoulas report improvement in their clinical knowledge, patient advocacy, and communication skills. Clinical exposureto abortion care and patient support during medical school as teledoulas can impact medical students’ awareness of reproductive health, support them in their career goals, and improve their self-perceived ability to communicate with patients. Target Audience: Medical curriculum coordinators References: 1. Pace L, Sandahl Y, Backus L, Silveira M, Steinauer J. Medical Students for Choice’s Reproductive Health Externships: impact on medical students’ knowledge, attitudes and intention to provide abortions. Contraception. 2008;28(1):31-35. doi:10.1016/j.contraception.2008.02.008. 2. Jones RK and Jerman J, Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014. American Journal of Public Health. 2017;107(12):1904-1909. doi:10.2105/AJPH.2017.304042. 3. Espey E, Ogburn T, Chavez A, Qualls C, Leyba M. Abortion education in medical schools: A national survey. Am J Obstet Gynecol. 2005;192(2):640-643. doi:10.1016/j.ajog.2004.09.013 4. Espey E, Ogburn T, Leeman L, Nguyen T, Gill G. Abortion education in the medical curriculum: a survey of student attitudes. Contraception. 2008;77(3):205-208. doi:10.1016/j.contraception.2007.11.011 5. Aiken ARA, Starling JE, Gomperts R, Tec M, Scott JG, Aiken CE. Demand for Self-Managed Online Telemedicine Abortion in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol. 2020;136(4):835-837. doi: 10;1097/AOG.0000000000004081

Over-The-Counter Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu

Since the United States Food and Drug Administration’s approval of over-the-counter levonorgestrel emergency contraception, access to this time-sensitive medication has improved. However, multiple barriers, including the cost of the medication and pharmacy availability, still exist. The objective of this study was to determine the over-the-counter availability of levonorgestrel emergency contraception in pharmacies on Oahu, Hawaii. We conducted a cross-sectional population-based study using in-person simulated patient encounters at all pharmacies on Oahu. Out of 109 chain pharmacies and 13 independent pharmacies, 102 (84%) pharmacies had levonorgestrel emergency contraception available over the counter. Of pharmacies in which it was available, 12.7% required an employee to unlock the medication, 37.3% required the medication to be unlocked at the register, 29.4% were packaged in a large plastic box, and 3.9% were packaged in a blister pack. Levonorgestrel emergency contraception is widely available as an over-the-counter medication in pharmacies on Oahu, yet there are packaging and display practices that make it less accessible. Many of these practices could be improved with pharmacy education or changes in store policies. Systems-based interventions are needed to improve the access to levonorgestrel emergency contraception as an over-the-counter medication

Abortion education: teaching the next generation of clinicians

Abstract Abortion is a safe and common part of essential healthcare. To ensure patients have access to comprehensive reproductive care, clinical educators are tasked with training the next generation of clinicians in abortion care in the setting of growing restrictions. Medical schools and residency program programs must adopt purposeful strategies to optimize abortion education and increase educational efficacy. Abortion training should ideally combine hands-on clinical skills such as ultrasound imaging and procedural abortion techniques, as well as discussions of medical ethics, advocacy, and strategies to emotionally support patients