Sequeira Gina M, Kahn Nicole F, Bocek Kevin M, Shafii Taraneh, Asante Peter G, Christakis Dimitri A, Pratt Wanda, Richardson Laura P
Seattle Children's Research Institute, Seattle, WA, United States.
Department of Pediatrics, University of Washington, Seattle, WA, United States.
JMIR Hum Factors. 2023 Jan 31;10:e39118. doi: 10.2196/39118.
Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs' preferences regarding receiving this support.
This study aimed to explore pediatric PCPs' perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting.
PCPs who had previously requested support from the Seattle Children's Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework.
The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient-specific consultation. The benefits of the electronic consultation platform were convenient and efficient communication, documentation in the electronic health record, the ability to bill for provider time, and sufficient time to synthesize information. The drawbacks of this platform were electronic health record-related difficulties, text-based communication challenges, inability to receive an answer in real time, forced conversations with patients about billing, and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, the benefits were having a dialogue with a specialist, receiving compensation for PCP's time, and helping with high acuity or complex cases. The drawbacks were challenges associated with using the phone for communication, the limited expertise of the responding providers, and the lack of utility for nonemergent issues. Regarding the most effective platform, the responses were mixed, with 27% (4/15) preferring the electronic consultation, 27% (4/15) preferring tele-education, 20% (3/15) preferring telephonic consultation, and the remaining 27% (4/15) suggesting a hybrid of the 3 models.
A diverse suite of telehealth-based training and consultation services must be developed to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence and promote wider access to gender-affirming care.
跨性别和性别多样化青少年获得性别肯定性医疗服务的机会有限，部分原因是目前此类服务主要由专科医生提供。使初级保健提供者（PCP）能够接受专科医生教育并进行咨询的远程医疗平台可能有助于改善此类服务的可及性。然而，对于初级保健提供者接受这种支持的偏好知之甚少。
本研究旨在探讨儿科初级保健提供者对于以远程医疗为基础提供支持的最佳方式的看法，以促进在初级保健环境中提供性别肯定性医疗服务。
招募了曾向西雅图儿童性别诊所寻求支持的初级保健提供者参与为期1小时的半结构化网络访谈。总体上，描述了3种专科医生与初级保健提供者之间的远程医疗模式（远程教育、电子咨询和电话咨询），并邀请参与者分享他们对每种模式的优缺点、哪种模式最有效以及成功平台的最重要特征或结果的看法。访谈记录采用反思性主题分析框架进行转录和分析。
对15名儿科初级保健提供者进行了访谈。远程教育平台的优点包括与其他初级保健提供者建立网络以促进共同学习、接受全面的理论和基于案例的教育、安排教育课程以及增强提供者信心。缺点是需要大量时间投入且不允许进行实时、针对患者的咨询。电子咨询平台的优点包括便捷高效的沟通、电子健康记录中的文档记录、为提供者时间计费的能力以及有足够时间综合信息。该平台的缺点包括与电子健康记录相关的困难、基于文本的沟通挑战、无法实时获得答案、迫使与患者谈论计费问题以及对缺乏基础知识的提供者的限制。关于电话咨询，优点是与专科医生进行对话、为初级保健提供者的时间获得补偿以及帮助处理高急症或复杂病例。缺点是与使用电话进行沟通相关的挑战、回复提供者的专业知识有限以及对非紧急问题无用。关于最有效的平台，回答不一，27%（4/15）的人更喜欢电子咨询，27%（4/15）的人更喜欢远程教育，20%（3/15）的人更喜欢电话咨询，其余27%（4/15）的人建议采用这3种模式的混合模式。
必须开发一系列多样化的基于远程医疗的培训和咨询服务，以满足在性别肯定性医疗方面具有不同经验和培训水平的初级保健提供者的需求。除了广泛使用的电话咨询模式外，电子咨询和远程教育可能提供重要的替代培训和咨询机会，以促进初级保健提供者更大程度的独立性，并促进更广泛地获得性别肯定性医疗服务。
