Yale National Clinician Scholars Program, Yale Department of Emergency Medicine, New Haven, CT.
Alpert Medical School of Brown University, Providence, RI.
Ann Emerg Med. 2018 Feb;71(2):170-182.e1. doi: 10.1016/j.annemergmed.2017.05.002. Epub 2017 Jul 14.
Transgender, gender-variant, and intersex (trans) people have decreased access to care and poorer health outcomes compared with the general population. Little has been studied and documented about such patients' emergency department (ED) experiences and barriers to care. Using survey and qualitative research methods, this study aims to identify specific areas for improvement and generate testable hypotheses about the barriers and challenges for trans individuals needing acute care.
A survey and 4 focus groups were conducted with trans individuals older than 18 years who had been to an ED in the last 5 years. Participants were recruited by trans e-mail listservs; outreach to local trans organizations; and lesbian, gay, bisexual, and transgender periodical advertisements. The interview guide was reviewed by qualitative research and trans health content experts. Deidentified participant demographic information was collected with a standardized instrument. All discussions were captured on digital audio recorders and professionally transcribed. Interview coding and thematic analysis were conducted with a grounded theory approach.
Among 32 participants, 71.9% were male identified and 78.1% were white. Nearly half (43.8%) reported avoiding the ED when they needed acute care. The factors that had the greatest influence on ED avoidance were fear of discrimination, length of wait, and negative previous experiences. There were 4 overarching discussion themes: system structure, care competency, discrimination and trauma, and avoidance of emergency care. Improvement recommendations focused on staff and provider training about gender and trans health, assurance of private gender identity disclosure, and accurate capture of sex, gender, and sexual orientation information in the electronic medical record.
Efforts to improve trans ED experiences should focus on provider competency and communication training, electronic medical record modifications, and assurance of private means for gender disclosure. Future research directions include quantifying the frequency of care avoidance, the effect of avoidance on trans patient morbidity and mortality, and comparing ED patient outcomes by gender identity. Further research with increased inclusion of transwomen and people of color is needed to identify themes that may not have been raised in this preliminary investigation.
与普通人群相比，跨性别者、性别多样化者和雌雄间性者（跨性别者）获得医疗服务的机会减少，健康状况较差。关于这些患者在急诊室（ED）的经历和获得医疗服务的障碍，几乎没有研究和记录。本研究采用调查和定性研究方法，旨在确定需要改进的具体领域，并提出关于需要急性护理的跨性别个体的障碍和挑战的可检验假设。
对过去 5 年内去过 ED 的年龄在 18 岁以上的跨性别者进行了一项调查和 4 组焦点小组。参与者通过跨性别电子邮件列表、当地跨性别组织外展以及女同性恋、男同性恋、双性恋和跨性别期刊广告招募。采访指南由定性研究和跨性别健康内容专家进行了审查。使用标准化仪器收集了参与者的匿名人口统计学信息。所有讨论都用数字音频记录器记录下来，并由专业人员转录。使用扎根理论方法对访谈进行编码和主题分析。
在 32 名参与者中，71.9%的人自我认同为男性，78.1%的人是白人。近一半（43.8%）的人表示，在需要急性护理时会避免去 ED。对 ED 回避影响最大的因素是对歧视的恐惧、等待时间的长短和负面的以往经历。有 4 个总体讨论主题：系统结构、护理能力、歧视和创伤以及对急诊护理的回避。改进建议集中在工作人员和提供者对性别和跨性别健康的培训、保证性别认同的隐私披露，以及在电子病历中准确捕获性别、性别和性取向信息。
改善跨性别者 ED 体验的努力应集中在提供者能力和沟通培训、电子病历修改以及保证性别披露的私人手段上。未来的研究方向包括量化避免护理的频率、避免护理对跨性别患者发病率和死亡率的影响，以及比较按性别认同划分的 ED 患者结局。需要进一步增加跨性别女性和有色人种的研究，以确定在本初步调查中可能未提出的主题。
