“初级保健就是初级保健”：利用规范化进程理论探索安大略省为跨性别者提供初级保健服务的实施情况。
"Primary care is primary care": Use of Normalization Process Theory to explore the implementation of primary care services for transgender individuals in Ontario.
机构信息
School of Nursing, McMaster University, Hamilton, Ontario, Canada.
M. Louise Fitzpatrick School of Nursing, Villanova University, Villanova, Pennsylvania, United States of America.
出版信息
PLoS One. 2019 Apr 22;14(4):e0215873. doi: 10.1371/journal.pone.0215873. eCollection 2019.
BACKGROUND
In Ontario, Canada, healthcare for transgender individuals is accessed through primary care; however, there are a limited number of practitioners providing transgender care, and patients are often on waiting lists and/or traveling great distances to receive care. Understanding how primary care is implemented and delivered to transgender individuals is key to improving access and eliminating healthcare barriers. The purpose of this study is to understand how the implementation of primary care services for transgender individuals compares across various models of primary care delivery in Ontario.
METHODS
A qualitative, exploratory, multiple-case study guided by Normalization Process Theory (NPT) was used to compare transgender care delivery and implementation across three primary care models. Three cases known to provide transgender primary care and represent different primary care models in Ontario, Canada (i.e., family health team, community health centre, fee-for service physician) were explored. The NoMAD survey, a tool to measure implementation processes, and qualitative interviews with primary care practitioners and allied healthcare staff were administered.
RESULTS
Using the NPT framework to guide analysis, key themes emerged about successful implementation of primary care services for transgender individuals. These themes include creating a safe space for patients, identifying gaps in services, understanding practitioners' roles, and the need for more training and education in transgender care for practitioners.
CONCLUSIONS
Primary care services for transgender individuals can and should be delivered in all models of primary care. Training and awareness for healthcare practitioners are needed to develop capacity in providing primary care to transgender individuals. A greater number of practitioners and organizations are needed to take on this work, embedding and normalizing transgender care into routine practice to address barriers to access and improve quality of care for transgender individuals.
背景
在加拿大安大略省，跨性别者的医疗保健通过初级保健获得；然而，提供跨性别护理的从业者数量有限，患者经常需要等待名单和/或长途旅行才能获得护理。了解如何向跨性别者实施和提供初级保健服务对于改善获取途径和消除医疗保健障碍至关重要。本研究的目的是了解在安大略省，各种初级保健提供模式下，向跨性别者提供初级保健服务的实施情况如何进行比较。
方法
采用以常规过程理论（NPT）为指导的定性、探索性、多案例研究方法，比较安大略省三种初级保健模式下的跨性别护理提供和实施情况。探索了三个已知为跨性别者提供初级保健并代表安大略省不同初级保健模式的案例（即家庭健康团队、社区健康中心、按服务收费医生）。使用 NoMAD 调查（一种衡量实施过程的工具）和对初级保健从业者和联合医疗保健人员的定性访谈进行了调查。
结果
使用 NPT 框架指导分析，出现了关于成功实施跨性别者初级保健服务的关键主题。这些主题包括为患者创造安全空间、确定服务差距、了解从业者的角色以及需要为跨性别护理从业者提供更多培训和教育。
结论
可以而且应该在所有初级保健模式下提供跨性别者的初级保健服务。需要对医疗保健从业者进行培训和提高认识，以培养向跨性别者提供初级保健的能力。需要更多的从业者和组织来承担这项工作，将跨性别护理纳入常规实践，以解决获取障碍并改善跨性别者的护理质量。
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