Shipherd Jillian C, Kauth Michael R, Matza Alexis
1 Lesbian, Gay, Bisexual and Transgender Program, Office of Patient Care Services, Veterans Health Administration , Washington, District of Columbia.
2 National Center for PTSD, Women's Health Sciences Division , Boston, Massachusetts.
Telemed J E Health. 2016 Dec;22(12):1008-1012. doi: 10.1089/tmj.2016.0013. Epub 2016 May 9.
Veteran's Health Administration (VHA) requires the provision of quality transgender care for the relatively large number of transgender veterans using VHA services.
The Office of Patient Care Services has taken a multimethod approach to improving provider knowledge and skill for transgender veteran care. However, unique patient-specific questions can arise. Thus, VHA implemented a 3-year feasibility program to determine if nationwide interdisciplinary e-consultation can offer veteran-specific consultation to providers who treat transgender veterans in VHA.
Launch of this program is described along with use to date, types of questions submitted by providers, and length of time to complete a response in the veteran's electronic medical record.
In 17 months, the program responded to 303 e-consults, with consultation provided on the care of 230 unique veterans. Nationwide coverage was achieved 1 year after the launch of the program. Common consult questions have been about medications, including hormones (n = 125); primary care concerns (n = 97); mental health evaluations (n = 63); and psychotherapy (n = 18). Consistent with the interdisciplinary model, multiple disciplines typically responded to each consult (x = 2.27). Average time to completion of a consult was 5.9 calendar days (range = 2.4-7.7 days).
VHA has established a nationwide interdisciplinary e-consultation program. Additional outreach about the program will be needed if funding is continued.
E-consultation on transgender health within VHA is feasible and complements the suite of trainings offered within VHA. Other healthcare organizations may benefit from a similar program.
退伍军人健康管理局（VHA）要求为使用VHA服务的数量相对较多的跨性别退伍军人提供高质量的跨性别医疗服务。
患者护理服务办公室采取了多种方法来提高医疗服务提供者对跨性别退伍军人护理的知识和技能。然而，可能会出现独特的患者特定问题。因此，VHA实施了一项为期三年的可行性计划，以确定全国范围内的跨学科电子咨询是否可以为在VHA治疗跨性别退伍军人的医疗服务提供者提供针对退伍军人的咨询服务。
描述了该计划的启动情况以及迄今为止的使用情况、医疗服务提供者提交的问题类型，以及在退伍军人电子病历中完成回复的时间长度。
在17个月内，该计划回复了303次电子咨询，为230名不同的退伍军人提供了护理咨询。该计划启动一年后实现了全国覆盖。常见的咨询问题涉及药物治疗，包括激素（n = 125）；初级保健问题（n = 97）；心理健康评估（n = 63）；以及心理治疗（n = 18）。与跨学科模式一致，通常多个学科会对每次咨询做出回复（x = 2.27）。完成一次咨询的平均时间为5.9个日历日（范围 = 2.4 - 7.7天）。
VHA已经建立了一个全国性的跨学科电子咨询计划。如果继续提供资金，将需要对该计划进行更多的推广。
VHA内部关于跨性别健康的电子咨询是可行的，并且补充了VHA提供的一系列培训。其他医疗保健组织可能会从类似的计划中受益。
