1 The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
LGBT Health. 2017 Apr;4(2):141-152. doi: 10.1089/lgbt.2016.0107. Epub 2017 Feb 21.
Research suggests that LGBT populations experience barriers to healthcare. Organizations such as the Institute of Medicine recommend routine documentation of sexual orientation (SO) and gender identity (GI) in healthcare, to reduce LGBT disparities. We explore patient views regarding the importance of SO/GI collection, and patient and provider views on risks and benefits of routine SO/GI collection in various settings.
We surveyed LGBT/non-LGBT patients and providers on their views on SO/GI collection. Weighted data were analyzed with descriptive statistics; content analysis was conducted with open-ended responses.
One-half of the 1516 patients and 60% of 429 providers were female; 64% of patients and 71% of providers were White. Eighty percent of providers felt that collecting SO data would offend patients, whereas only 11% of patients reported that they would be offended. Patients rated it as more important for primary care providers to know the SO of all patients compared with emergency department (ED) providers knowing the SO of all patients (41.3% vs. 31.6%; P < 0.001). Patients commonly perceived individualized care as an SO/GI disclosure benefit, whereas providers perceived patient-provider interaction improvement as the main benefit. Patient comments cited bias/discrimination risk most frequently (49.7%; N = 781), whereas provider comments cited patient discomfort/offense most frequently (54.5%; N = 433).
Patients see the importance of SO/GI more in primary care than ED settings. However, many LGBT patients seek ED care due to factors including uninsurance; therefore, the ED may represent an initial point of contact for SO/GI collection. Therefore, patient-centered approaches to collecting SO/GI are needed. Patients and providers differed in perceived risks and benefits to routine SO/GI collection. Provider training in LGBT health may address patients' bias/discrimination concerns, and ultimately reduce LGBT health disparities.
研究表明，LGBT 群体在医疗保健方面存在障碍。医学研究所等组织建议在医疗保健中常规记录性取向（SO）和性别认同（GI），以减少 LGBT 群体的差异。我们探讨了患者对 SO/GI 采集重要性的看法，以及患者和提供者对不同环境中常规 SO/GI 采集的风险和益处的看法。
我们调查了 LGBT/非 LGBT 患者和提供者对 SO/GI 采集的看法。使用描述性统计对加权数据进行分析；对开放式回答进行内容分析。
1516 名患者中有一半和 429 名提供者中有 60%为女性；64%的患者和 71%的提供者为白人。80%的提供者认为收集 SO 数据会冒犯患者，而只有 11%的患者表示会感到冒犯。患者认为，与知道所有患者 SO 的急诊部门（ED）提供者相比，初级保健提供者了解所有患者的 SO 更为重要（41.3%比 31.6%；P<0.001）。患者通常认为个性化护理是披露 SO/GI 的好处，而提供者认为改善医患互动是主要好处。患者的评论最常提到偏见/歧视风险（49.7%；N=781），而提供者的评论最常提到患者不适/冒犯（54.5%；N=433）。
患者认为 SO/GI 在初级保健中比在 ED 环境中更重要。然而，由于许多 LGBT 患者因没有保险等因素而寻求 ED 护理；因此，ED 可能是收集 SO/GI 的初始接触点。因此，需要采用以患者为中心的方法来收集 SO/GI。患者和提供者对常规 SO/GI 采集的风险和益处存在差异。对 LGBT 健康的提供者培训可能会解决患者的偏见/歧视问题，并最终减少 LGBT 健康差距。
