Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.
Equinox Gender Diverse Health Centre, Thorne Harbour Health, Fitzroy, Victoria, Australia.
J Sex Med. 2021 Jan;18(1):201-208. doi: 10.1016/j.jsxm.2020.10.020. Epub 2020 Nov 26.
There are 2 common approaches to assess an individual before commencing of gender-affirming hormone therapy (GAHT); a mental health practitioner assessment and approval or an informed consent model undertaken with a primary care general practitioner (GP).
In a primary care clinic practising an Informed Consent Model of care to initiate GAHT, we aimed to firstly describe the proportion and characteristics of patients referred for secondary consultation to a mental health practitioner (MH referred) and secondly, we aimed to measure patient satisfaction.
A retrospective audit of all new patients with a transgender or gender diverse identity presenting to a primary care clinic in Melbourne, Australia was performed between March 2017 and March 2019. In those newly seeking GAHT, de-identified data were obtained including presence of secondary mental health practitioner referral, time to GAHT commencement and co-occurring mental health conditions. A separate survey assessed patient satisfaction.
Mental health conditions and overall patient satisfaction in those referred for secondary mental health consultation (MH referred) were compared with those who were not (GP assessed).
Of 590 new consultations, 309 were newly seeking GAHT. Referrals for secondary mental health assessment before GAHT occurred in 8%. The GP-assessed group commenced GAHT at median 0.9 months (0.5-1.8) after initial consultation compared with 3.1 months (1.3-4.0), P < .001 in the MH-referred group. The MH-referred group was more likely to have post-traumatic stress disorder (adjusted P = .036) and schizophrenia (adjusted P = .011). Of 43 respondents to the survey, a higher proportion in the GP-assessed group was extremely satisfied with their overall care compared with the MH-referred group (P < .01). Notably, 80% in the GP-assessed group chose to seek mental health professional support.
Initiation of GAHT can be performed in primary care by GPs using an informed consent model and is associated with high patient satisfaction. Mental health professionals remain a key source of support.
STRENGTHS & LIMITATIONS: This retrospective audit did not randomize patients to pathways to initiate GAHT. Follow-up duration was short. Responder bias to survey with low response rates may overestimate patient satisfaction. This is one of the first studies to evaluate an informed consent model of care.
More widespread uptake of an informed consent model of care to initiate GAHT by primary care physicians has the potential for high patient satisfaction and may be a practical solution to reduce waiting lists in gender clinics. Spanos C, Grace JA, Leemaqz SY, et al. The Informed Consent Model of Care for Accessing Gender-Affirming Hormone Therapy Is Associated With High Patient Satisfaction. J Sex Med 2021;18:201-208.
在开始进行性别肯定激素治疗（GAHT）之前，有两种常见的方法来评估个体；一种是心理健康从业者评估和批准，另一种是在初级保健全科医生（GP）处进行知情同意模式。
在一个以知情同意模式为护理基础的初级保健诊所中，我们旨在首先描述向心理健康从业者（MH 转介）转介的患者的比例和特征，其次，我们旨在衡量患者的满意度。
对 2017 年 3 月至 2019 年 3 月期间在澳大利亚墨尔本的一家初级保健诊所就诊的所有具有跨性别或性别多样化身份的新患者进行了回顾性审计。在那些新寻求 GAHT 的人中，获得了包括二级心理健康从业者转介、开始 GAHT 的时间和并发心理健康状况的去识别数据。单独的调查评估了患者的满意度。
在接受二级心理健康咨询（MH 转介）的患者中，心理健康状况和整体患者满意度与未接受二级心理健康咨询的患者（GP 评估）相比。在开始 GAHT 之前，GP 评估组中位数为 0.9 个月（0.5-1.8），而 MH 转介组为 3.1 个月（1.3-4.0），P<0.001。MH 转介组更有可能患有创伤后应激障碍（调整后的 P=0.036）和精神分裂症（调整后的 P=0.011）。在接受调查的 43 名受访者中，与 MH 转介组相比，GP 评估组中更高比例的患者对整体护理非常满意（P<0.01）。值得注意的是，80%的 GP 评估组选择寻求心理健康专业人员的支持。
初级保健医生可以使用知情同意模式来启动 GAHT，这与患者的高满意度有关。心理健康专业人员仍然是关键的支持来源。
这项回顾性审计并未对启动 GAHT 的途径对患者进行随机分组。随访时间短。对调查的回应者偏见和低回应率可能会高估患者的满意度。这是评估知情同意护理模式的首批研究之一。
初级保健医生更广泛地采用知情同意模式来启动 GAHT，这有可能获得高患者满意度，并且可能是减少性别诊所等候名单的实用解决方案。
