Vupputuri Suma, Daugherty Stacie L, Yu Kalvin, Derus Alphonse J, Vasquez Laura E, Wells Ayanna, Truong Christine, Emanuel E W
Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Medical Group, Rockville, MD 20852, USA.
Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Healthcare (Basel). 2021 May 2;9(5):530. doi: 10.3390/healthcare9050530.
Transgender and gender nonconforming (TGNC) patients have been seeking medical care in higher numbers and have faced unique social, personal, and health issues that affect the quality of care they receive. The purpose of this study was to conduct a mixed-methods study to describe TGNC care at Kaiser Permanente Mid-Atlantic States, a large integrated health system. We used a transgender registry to describe a TGNC patient population and compared healthcare utilization between TGNC patients and non-TGNC patients. Four focus groups were also conducted among 28 patients. Atlas.ti software was used to code and analyze themes for the qualitative analysis. Among the 282 adults TGNC patients, the mean age was 32.6 years. Of the study sample, 59% were White, and 27% were Black. TGNC patients demonstrated an increased use of email/telephone visits and the online patient portal and more cancellations and no-shows compared to non-TGNC controls. Of the 28 TGNC patients who participated in the focus groups, 39% identified as female, 21% as a transman, and 18% as non-binary/genderqueer. Participants were predominantly White (68%), highly educated (74%), and reported use of hormones (89%). Themes that emerged from our qualitative analysis included: limited availability of TGNC information; positive and negative sentiments regarding patient-provider interactions; issues with case management; limited access to care; lack of coordination of care; negative staff experiences. We identified specific areas in a health system to improve the quality of care of TGNC patients, including specific TGNC training for providers and staff, a source of TGNC information/resources, and hiring and training TGNC-specific case managers.
跨性别和性别不一致（TGNC）患者寻求医疗护理的人数越来越多，他们面临着独特的社会、个人和健康问题，这些问题影响着他们所接受护理的质量。本研究的目的是进行一项混合方法研究，以描述大型综合医疗系统凯撒永久医疗集团中大西洋各州的TGNC护理情况。我们使用了一个跨性别登记册来描述TGNC患者群体，并比较了TGNC患者和非TGNC患者之间的医疗保健利用率。我们还对28名患者进行了四个焦点小组访谈。使用阿特拉斯.ti软件对定性分析的主题进行编码和分析。在282名成年TGNC患者中，平均年龄为32.6岁。在研究样本中，59%为白人，27%为黑人。与非TGNC对照组相比，TGNC患者使用电子邮件/电话就诊和在线患者门户的频率更高，取消预约和爽约的情况也更多。在参与焦点小组访谈的28名TGNC患者中，39%认定为女性，21%认定为跨性别男性，18%认定为非二元性别/酷儿性别。参与者主要是白人（68%），受过高等教育（74%），并且报告使用过激素（89%）。我们定性分析中出现的主题包括：TGNC信息的可用性有限；关于患者与提供者互动的积极和消极情绪；病例管理问题；获得护理的机会有限；护理缺乏协调；工作人员的负面经历。我们确定了医疗系统中可以提高TGNC患者护理质量的特定领域，包括为提供者和工作人员提供特定的TGNC培训、TGNC信息/资源的来源，以及招聘和培训特定的TGNC病例经理。
