Brighton and Sussex Medical, University of Sussex, Brighton, UK.
Independent Transgender Community Researcher, Brighton, UK.
Eur J Gen Pract. 2024 Dec;30(1):2296571. doi: 10.1080/13814788.2023.2296571. Epub 2024 Jan 10.
Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK.
This systematic review aims to summarise the evidence regarding TNB people's experiences of primary care to inform improvements in service and patient outcomes.
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative.
Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities.
This review demonstrates TNB people's mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.
跨性别和非二元性别（TNB）者在获得初级保健方面面临障碍，而初级保健仍然是在英国获得性别肯定医疗保健的主要切入点。
本系统评价旨在总结 TNB 者在初级保健方面的经验证据，以改善服务和患者的结果。
本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）报告准则。对 2005 年至 2023 年 4 月期间在 Ovid Medline、Ovid Embase 和 PsychInfo 上的与性别认同、初级保健和经验相关的既定关键词进行了系统文献检索。对定性数据进行主题分析，对定量数据进行描述性叙述。
根据纳入标准，本研究共纳入 16 篇文章。本研究确定了 TNB 者在初级保健提供者知识方面、医患关系和医疗保健环境方面所经历的促进因素和限制因素以及障碍。定量研究结果报告称，高达 54.4%的参与者在与医生讨论 TNB 问题时感到不舒服。总体研究结果表明，TNB 者在系统层面上在利用初级保健服务时面临歧视，但也有报告称在当地层面上获得了积极的医疗保健体验。参与者表示希望初级保健主导的性别肯定医疗保健服务，并希望当地的 TNB 社区参与其中。
本研究展示了 TNB 者在初级保健方面的混合体验，以及他们对服务改进的建议。这是该主题的首次系统综述证据，强调了临床医生和政策制定者需要将 TNB 社区的声音纳入服务设计和改进中。
