Irene Park Ulrich, PharmD, BCACP, CPP; Chase Harless, MSW; Gwen Seamon, PharmD, CPP; Annie Kim, PharmD; Lindsay Sullivan, PharmD; Jenna Caldwell, PharmD; Lisa Reed, MD; Heidi Knoll, MD
Corresponding Author: Irene Park Ulrich, PharmD, BCACP, CPP; MAHEC Department of Family Medicine - UNC School of Medicine.
Contact Email: Irene.Ulrich@mahec.net
Section: Original Research
Publication Date: 3/22/2022
PURPOSE: Numerous studies have shown that transgender or gender non-binary (TGNB) individuals encounter significantly more health care barriers including overall lack of access to gender-affirming care providers. This study describes two assessments of transgender care services at a large family medicine teaching practice.
METHODS: Staff and providers were invited to attend an optional, practice-wide, hour-long free training session on gender-affirming care offered on three different dates in 2019. A structured protocol was used to collect observational data from which key takeaways from the training sessions were developed. Separately, a retrospective chart review of patients with a gender dysphoria diagnosis was completed. Charts were reviewed for adherence to regional and international organization recommendations for comprehensive transgender care.
RESULTS: Three main takeaways from the training sessions included: lack of knowledge or familiarity with gender terminology and expression, fear of offending patients, and employee hesitation to change behaviors when interacting with patients. On chart review, the most common interventions identified were need to schedule a follow-up visit (61.5%), need for health maintenance screenings (osteoporosis screening, 50%; pap smear, 56.3%; mammogram, 66.7%), need for mental health screening (41.5%), need for laboratory monitoring of testosterone therapy (20%), and corrected gender markers/names listed in the appropriate place in the patient chart (16.9%).
CONCLUSIONS: This study highlighted hesitation to provide and lack of familiarity with transgender care among practice staff. While some aspects of comprehensive transgender care are well implemented, maintaining follow-up, completing health maintenance and mental health screenings and appropriate laboratory monitoring are areas for improvement.