Few California pharmacists prescribe birth control, a study finds

Photo by Anqa

It takes time and money to visit the doctor’s office to get birth control. This is particularly an issue for low-income women, those who live in rural areas and teenagers who feel uncomfortable seeing their family doctor.

So four states — California, Oregon, Colorado and New Mexico — are trying to make contraception cheaper and more readily available by allowing trained pharmacists to prescribe and dispense birth control pills, patches, injections and vaginal rings. However, pharmacists aren’t required to participate and few do, according to a new study.

University of California, Berkeley researchers investigated the availability and cost of pharmacist-prescribed contraception in California using a telephone audit survey of approximately 1000 community-based, retail pharmacies. Although randomly selected, most of the pharmacies were in urban areas and affiliated with retail chains, like CVS.

Posing as patients, they called the pharmacies and said, “I heard that you can get birth control from a pharmacy without a prescription from your doctor. Can I do that at your pharmacy?” If the answer was yes, then the researcher asked follow-up questions to identify the types of birth control available and the service fee.

The study found that pharmacy-prescribed birth control was available in only 11 percent of the surveyed pharmacies, with no availability differences between the rural or urban stores. They also determined that most participating pharmacies charged a service fee between $40 and $45.

“Our findings strongly suggest that more pharmacies need to offer this service to live up to the promise of widespread, easier access to birth control,” said lead author Anu Manchikanti Gómez, PhD, an assistant professor of social welfare at UC Berkeley, in a recent news release.

The authors noted that the current service fees may make birth control too expensive for some low-income women. They are hopeful this will improve once California’s Medicaid program starts reimbursing pharmacists for these services, which is required by July 2021.

They conclude the paper with a call for more research to identify the barriers to birth control accessibility.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Stanford study seeks to make cycling safer and more comfortable

Image by OpenClipart-Vectors
Image by OpenClipart-Vectors

When I think about bicycle safety, I think of helmets, lights and strategies to share the road with cars.

But physicians have a different perspective — too many hours on a bicycle saddle can compress vital arteries and nerves to cause numbness, pain and sexual dysfunction. This risk is likely affected by the design of the saddle, fit of the bike, riding position, ride duration and a host of other factors.

But there’s a lot that remains unknown. So Michael Eisenberg, MD, an assistant professor of urology at Stanford, is conducting the Stanford CYCling and Lower Effects (CYCLE) study to hone in on the factors affecting the comfort and safety of cycling. He’s collaborating with Roger Minkow, MD, a Bay Area-based saddle designer and ergonomic consultant.

The researchers are inviting volunteers to answer a brief online survey about their bicycling habits, equipment and health. I recently reached out to Eisenberg to learn more.

What inspired you to conduct the CYCLE study?

“About 20 years ago, several studies demonstrated an association between cycling, erectile dysfunction and even infertility. Many of these health issues can be reversed if caught early, but they can become permanent over time. Since then, the bicycle industry has undergone a major redesign of equipment to try to mitigate the risk. And it’s been years since a large study has been conducted to understand the current prevalence of sexual dysfunction in riders and to understand if there are cycling related factors — such as duration of riding and saddle design — that are contributing.

Cycling is quite popular in this area and I have several patients who have come in over the years complaining of genital pain, numbness or performance issues. Recently, the saddle designer Roger Minkow reached out to me about the topic. We created and initiated the CYCLE study in October 2016 to help understand the current state of cycling on pelvic and sexual health for male and female riders. We’re very excited about the study and hope it will help make the sport safer and more comfortable.”

How can cyclists participate?

“Cyclists participate in the study by completing a brief online survey that takes about 15 minutes. In the survey, we obtain a comprehensive look at the cycling habits of men and women, including the type of riding they do, their intensity level and details about their equipment. We then ask participants about their overall health — such as their weight, body measurements and basic medical history. Finally, we ask validated questions related to sexual function and how it corresponds to their riding habits.

Nearly 1500 people have participated in the study so far. There are so many different types of cyclists and equipment in common use. In order for us to effectively compare these, we need about 8500 more participants.”

Can you give an example of how you treat a cycling-related health problem?

“I recently saw a man with persistent penile numbness after several long bike rides. We reviewed risk factors and pelvic anatomy related to his condition. We then discussed certain cycle practices he can modify to allow him to be able to cycle as much as he’d like without the symptoms, and these modified practices have worked well.

In generally, cyclists really love to ride so my goal is not to tell them to stop. I look at a patient’s equipment, body position, saddle design, riding habits, and when symptoms occur — to come up with a personalized strategy for that rider. In select cases, I even prescribe some medications to help circulation.”

Do you cycle?

“Yes, I cycle on the road for both pleasure and exercise. We live in a beautiful area. One of my favorite rides is around my neighborhood along Foothill Expressway and Junipero Serra Boulevard.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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