1 Oklahoma City VA Medical Center , Oklahoma City, Oklahoma.
2 South Central Mental Illness Research, Education and Clinical Center .
LGBT Health. 2014 Sep;1(3):185-91. doi: 10.1089/lgbt.2014.0008. Epub 2014 Apr 11.
Despite known health disparities for lesbian, gay, and bisexual (LGB) individuals, research in the civilian sector has documented low rates of patient disclosure and provider assessment of this domain. Very little is known about Veterans Health Affairs (VHA) providers' care of LGB veterans, a population that has been relatively invisible until recently because of the vestiges of the Department of Defense policy of "Don't Ask, Don't Tell." This study examined the attitudes, beliefs, and clinical practices of VHA healthcare providers regarding sexual minority veterans.
Physical and mental health VHA healthcare providers (n=202) from two southern VHA hospitals completed an anonymous self-report questionnaire. Measures included comfort in providing care to LGB veterans, factors affecting decisions about assessing sexual orientation with veterans, and attitudes toward sexual minority individuals.
Although approximately half of VHA providers thought that sexual orientation should be routinely discussed, the providers rarely assessed this issue with their patients. Over half of providers believed that veterans would disclose their sexual orientation if it was important to them, and almost half of providers believed sexual orientation is not relevant to healthcare.
Many VHA providers may be unaware of the unique health disparities experienced by LGB individuals. Culturally appropriate care cannot be provided to LGB veterans unless providers explicitly assess sexual orientation in healthcare visits. Central to this assessment is providing patients with a clear rationale for the purpose of the assessment and related documentation. Staff training is needed to address providers' beliefs and reservations about discussing sexual orientation that emerged in this investigation.
尽管同性恋、双性恋和双性人(LGB)个体存在已知的健康差异,但民用部门的研究记录表明,患者披露和提供者评估这一领域的比例很低。对于退伍军人健康管理局(VHA)的提供者对 LGB 退伍军人的护理,人们知之甚少,这是一个直到最近才相对隐形的人群,因为国防部“不问,不说”政策的残余。本研究调查了 VHA 医疗保健提供者对性少数退伍军人的态度、信念和临床实践。
来自两家南部 VHA 医院的身体和心理健康 VHA 医疗保健提供者(n=202)完成了一份匿名自我报告问卷。测量包括为 LGB 退伍军人提供护理的舒适度、影响与退伍军人评估性取向的因素,以及对性少数群体的态度。
尽管约有一半的 VHA 提供者认为性取向应该定期讨论,但提供者很少与患者评估这个问题。超过一半的提供者认为,如果退伍军人认为这很重要,他们会透露自己的性取向,几乎一半的提供者认为性取向与医疗保健无关。
许多 VHA 提供者可能不知道 LGB 个体所经历的独特健康差异。除非提供者在医疗保健访问中明确评估性取向,否则无法为 LGB 退伍军人提供适当的护理。评估的核心是向患者提供评估目的和相关记录的明确理由。需要进行员工培训,以解决提供者在本研究中出现的关于讨论性取向的信念和保留意见。