Delahunt John W, Denison Hayley J, Kennedy Jane, Hilton Jackie, Young Heather, Chaudhri Owais B, Elston Marianne S
Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington 6242.
N Z Med J. 2016 May 6;129(1434):49-58.
In light of the rising number of referrals to secondary level services of people who identify as transgender, and the Human Rights Commission concerns regarding the care of this group in New Zealand, we felt it was timely to determine the availability of services for people who identify as transgender and whether there are variations in management protocols.
We contacted 100 physicians involved in providing a secondary level service to care for people who identify as transgender, and asked them to complete a questionnaire about the services available in their region. This questionnaire consisted of two parts, a 'general questionnaire', which focussed on the consultants' understanding of services available locally, and a 'clinical questionnaire', which presented hypothetical clinical case histories and asked respondents to indicate how they would manage the case.
Sixty-two of the physicians responded. Of these, 18 (45% of the 40 physicians that answered the question) believed they could access a psychological or psychiatric opinion in the public sector for a patient who identifies as transgender, whereas 28 (82% of the 34 that answered the question) knew of access in the private sector. There was a conflict of opinion on the availability of psychological and surgical services in several DHBs where there was more than one clinician responding. This may reflect the case experience of individual clinicians. There was restricted access to common surgical procedures in the public sector, and about half of respondents did not know if techniques were available locally.
Our results support the development of specialist care services in tertiary centres in addition to the secondary services already available in New Zealand for people who identify as transgender. Development of multidisciplinary management and improved access to psychological support services for individual cases is required.
鉴于转诊至二级医疗服务机构的跨性别者人数不断增加，以及人权委员会对新西兰这一群体护理情况的关注，我们认为及时确定跨性别者可获得的服务以及管理方案是否存在差异很有必要。
我们联系了100名参与为跨性别者提供二级医疗服务的医生，要求他们填写一份关于其所在地区可用服务的问卷。该问卷由两部分组成，一部分是“一般问卷”，重点关注顾问对当地可用服务的了解情况；另一部分是“临床问卷”，呈现假设的临床病例史，并要求受访者指出他们将如何处理该病例。
62名医生回复了问卷。其中，18名（回答该问题的40名医生中的45%）认为他们可以为跨性别患者在公共部门获得心理或精神科意见，而28名（回答该问题的34名医生中的82%）知道在私营部门可以获得。在有多名临床医生回复的几个地区卫生局，对于心理和手术服务的可获得性存在意见冲突。这可能反映了个别临床医生的病例经验。公共部门获得常见外科手术的机会有限，约一半的受访者不知道当地是否有相关技术。
我们的结果支持在三级中心发展专科护理服务，此外新西兰已经为跨性别者提供二级服务。需要制定多学科管理方案，并改善个别病例获得心理支持服务 的机会。
