From the Department of Family Medicine (IPU, LR), Department of Research and Library Sciences (CH), and Family Medicine Residency Program (HK), Mountain Area Health Education Center (MAHEC), Asheville, NC (IPU); UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC (IPU); Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (IPU, LR, HK); MAHEC/UNC Eshelman School of Pharmacy, Asheville, NC (IPU); Mountain Community Health Partnership, Burnsville, NC (GS); UCSF Health, San Francisco, CA (AK); Mission Hospital, Asheville, NC (LS); and UNC Eshelman School of Pharmacy & Walgreen Co., Asheville, NC (JC).
J Am Board Fam Med. 2022 Mar-Apr;35(2):235-243. doi: 10.3122/jabfm.2022.02.210182.
Numerous studies have shown that transgender or gender nonbinary (TGNB) individuals encounter significantly more health care barriers, including overall lack of access to gender-affirming care providers. This study describes 2 assessments of transgender care services at a large family medicine teaching practice.
Staff and providers were invited to attend an optional, practice-wide, hourlong free training session on gender-affirming care offered on 3 different dates in 2019. A structured protocol was used to collect observational data from which key takeaways from the training sessions were developed. Separately, a retrospective chart review of patients with a gender dysphoria diagnosis was completed. Charts were reviewed for adherence to regional and international organization recommendations for comprehensive transgender care.
Three main takeaways from the training sessions included lack of knowledge or familiarity with gender terminology and expression, fear of offending patients, and employee hesitation to change behaviors when interacting with patients. On chart review, the most common interventions identified were need to schedule a follow-up visit (61.5%), need for health maintenance screenings (osteoporosis screening, 50%; Papanicolaou smear, 56.3%; mammogram, 66.7%), need for mental health screening (41.5%), need for laboratory monitoring of testosterone therapy (20%), and corrected gender markers/names listed in the appropriate place in the patient chart (16.9%).
This study highlighted hesitation to provide and lack of familiarity with transgender care among practice staff. Although some aspects of comprehensive transgender care are well implemented, maintaining follow-up, completing health maintenance and mental health screenings, and appropriate laboratory monitoring are areas for improvement.
许多研究表明，跨性别者或性别非二元者（TGNB）在获得医疗保健方面面临着更大的障碍，包括整体上无法获得性别肯定护理提供者。本研究描述了在一家大型家庭医学教学实践中对跨性别护理服务的 2 项评估。
邀请工作人员和医务人员参加 2019 年 3 个不同日期举行的可选、全面的、长达 1 小时的关于性别肯定护理的免费培训课程。使用结构化协议从培训课程中收集观察数据，并从中开发出关键要点。另外，对有性别焦虑症诊断的患者进行了回顾性图表审查。对图表进行审查，以遵守区域和国际组织关于全面跨性别护理的建议。
培训课程的三个主要收获包括缺乏对性别术语和表达的了解或熟悉、害怕冒犯患者，以及员工在与患者互动时改变行为的犹豫。在图表审查中，确定的最常见干预措施包括需要预约随访（61.5%）、需要进行健康维护筛查（骨质疏松症筛查，50%；巴氏涂片检查，56.3%；乳房 X 光检查，66.7%）、需要进行心理健康筛查（41.5%）、需要监测睾丸激素治疗的实验室监测（20%），以及在患者图表的适当位置纠正性别标记/姓名（16.9%）。
本研究强调了实践工作人员提供和熟悉跨性别护理方面的犹豫。尽管全面的跨性别护理的某些方面实施得很好，但保持随访、完成健康维护和心理健康筛查以及适当的实验室监测是需要改进的领域。
