By integrating such care into existing primary care settings, we would expect to see more transgender and gender-diverse people accessing health care treatment they might not otherwise receive with an overall improvement in their wellness and quality of life as a result.
BOSTON (PRWEB) January 15, 2020
A paper published in Annals of Family Medicine provides a concise and practical guide for physicians and others managing primary care practices on how to develop and integrate transgender health programs within existing practices. It is the first peer-reviewed publication on how to develop and deliver these potentially life-saving programs for an underserved but increasingly visible population that experiences significant health inequities.
Authored by leading educators and clinical experts on transgender health care from Harvard, Fenway Health, and The Fenway Institute, the paper was written in response to numerous requests from primary care organizations in need of assistance with planning and implementing transgender health programs.
“Transgender health experts now agree that gender-affirming hormone therapy can be safely delivered as part of routine care by a trained primary care clinician,” said Dr. Alex Keuroghlian, an author of the study who directs the National LGBT Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “By integrating such care into existing primary care settings, we would expect to see more transgender and gender-diverse people accessing health care treatment they might not otherwise receive with an overall improvement in their wellness and quality of life as a result.”
Organizations with the resources to do so are advised to consult with the local community via focus groups and interviews with transgender and gender-diverse community leaders to assess the community’s needs. Practices that do not have the financial or staff capacity to conduct a formal needs assessment are advised to begin by training clinicians on relevant care guidelines for transgender and gender-diverse patients, providing gender-affirming medical treatments, and building a referral network for surgeries and other external services.
All of the suggestions in the paper can be adapted for small practices with one or two trained clinicians providing hormone therapy within a welcoming environment as well as larger practices with the capacity to deliver comprehensive gender-affirming care, including primary care, endocrinology, gynecology, mental health, voice therapy, and surgical care.
“Regardless of the size of the practice, it’s important that all patient-centered staff, both clinical and nonclinical, receive training on how to effectively communicate with transgender and gender-diverse patients,” said Keuroghlian. “Such training would cover the importance of using patients’ correct names and pronouns, maintaining confidentiality of gender identities, avoiding assumptions about gender, being open to nonbinary gender identities, and avoiding questions not pertinent to care.”
Other issues addressed in the paper include:
- Accessing low-cost clinical training.
- Addressing staff concerns and resistance that can arise with the implementation of any new program, but especially one that is focused on a stigmatized population. Tips include holding staff presentations that emphasize how offering transgender health care will position the organization at the vanguard of reducing health disparities, and how gender-affirming care aligns with the principles of medical ethics, such as beneficence and justice. Inviting transgender and gender-diverse people to speak with staff about their personal experiences seeking health care is also helpful.
- Suggested staff roles and competencies for a primary care transgender health program including primary care clinicians, behavioral health clinicians, case managers, front desk/patient service representatives, medical assistants, and program directors.
- Covering financial costs of care, which may necessitate the hiring of care navigators who can advocate for treatment coverage by health insurers.
- Collecting and recording patient data on gender identity in electronic health records.
- Creating welcoming environments that include clearly labeled all-gender restrooms, prominently posted nondiscrimination policies, and intake forms with dedicated space for a full range of gender identities, sexual orientations, chose names, pronouns, and names on insurance and legal documents.
- Providing trauma-informed care that recognizes that transgender and gender-diverse patients may need additional choices and autonomy to engage in particular kinds of medical care, such as a self-administered cervical swab for human papillomavirus testing among trans masculine people.
Since 1971, Fenway Health has been working to make life healthier for the people in our neighborhoods, the LGBTQ community, people living with HIV/AIDS and the broader population. The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues.