Department of Medicine, Tufts Medical Center, Boston, MA.
Tufts University, Bendetson Hall, Medford, MA.
Med Care. 2024 Dec 1;62(12):814-819. doi: 10.1097/MLR.0000000000002076. Epub 2024 Oct 2.
Despite numerous calls for standardized collection of sexual orientation and gender identity (SOGI) data in clinical settings, uptake of this practice still lags.
This study conducted a preimplementation assessment of staff attitudes toward SOGI data collection within an adult primary care practice in an urban academic medical center in the northeastern United States.
We created a process map of the flow of patient data from the point of registration to the clinical encounter to identify all staff roles associated with registration and patient demographic data collection. We purposively sampled staff members across these roles and conducted semistructured virtual interviews between November 2021 and February 2022. The research team used deductive and inductive coding and conducted a thematic analysis to identify barriers and facilitators to implementation.
Nine clinical staff and eleven nonclinical staff were interviewed.
Participants were asked about their general experiences with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients, their perspectives on collecting this data, and potential barriers and facilitators to incorporating this into the workflow.
The main themes that emerged were the relevance of SOGI data to the clinical practice; concerns about patient acceptability; the prevalence of cis-gender, heteronormative assumptions; and concerns about linguistic, cultural, and generational differences. Differences were noted between clinical and nonclinical staff.
Greater education is needed to help both clinical and nonclinical staff understand how patients' SOGI demographics can be used to provide affirming, patient-centered care. Implementation strategies can be tailored to address specific barriers at the individual, organizational, and social levels.
尽管人们多次呼吁在临床环境中标准化收集性取向和性别认同 (SOGI) 数据，但这一做法的采用仍落后。
本研究对美国东北部一所城市学术医疗中心的成人初级保健实践中工作人员对 SOGI 数据收集的态度进行了实施前评估。
我们创建了一个从患者注册点到临床就诊的患者数据流程图，以确定与注册和患者人口统计学数据收集相关的所有工作人员角色。我们在这些角色中进行了有针对性的抽样，并在 2021 年 11 月至 2022 年 2 月期间进行了半结构化虚拟访谈。研究团队使用演绎和归纳编码，并进行了主题分析，以确定实施的障碍和促进因素。
共采访了 9 名临床工作人员和 11 名非临床工作人员。
受访者被问及他们与 LGBTQ 患者的一般接触经验、他们对收集这些数据的看法以及将其纳入工作流程的潜在障碍和促进因素。
出现的主要主题是 SOGI 数据与临床实践的相关性；对患者可接受性的关注；顺性别、异性恋规范假设的普遍性；以及对语言、文化和代际差异的关注。临床和非临床工作人员之间存在差异。
需要进行更多教育，以帮助临床和非临床工作人员了解如何利用患者的 SOGI 人口统计学数据提供支持、以患者为中心的护理。实施策略可以根据个人、组织和社会层面的具体障碍进行定制。
