Via Research Recognition Day 2024 VCOM-Carolinas

Educational Reports

Thematic Analysis: Barriers to Receiving Healthcare for Transgender Patients in the Primary Care Setting ĂŵĚĞŶ WĞƌĞŝƌĂ KD^ͲϮ͕ ůĂŝƌĞ ƐƚĞƉ͕ D KD^Ͳϯ͕ ůLJƐƐĂ ƌĞĞĚůŽǀĞ KD^Ͳϯ͕ ŽƌĂůLJŶ :ŽŶĞƐ K ĚǁĂƌĚ sŝĂ ŽůůĞŐĞ ŽĨ KƐƚĞŽƉĂƚŚŝĐ DĞĚŝĐŝŶĞ͕ ĂƌŽůŝŶĂƐ ĂŵƉƵƐ͕ ^WĂƌƚĂŶďƵƌŐ͕ ^

ƵƐ dŚĞ Ɖ ĨŽƌŵ ƉůĂĐĞ ĂŶ ŝĐ ^ŵĂƌ ŵƵůƚ dŽ ĂĚ ĨƌŽŵ ďƵƚƚŽ /Ĩ LJŽƵ ƚŝƚůĞƐ ŵĂŬĞ drag ^ŵĂƌ ǁŝƚŚ tĂŶ ŝŶƐƚĞ ƌŝŐŚƚ ŚĂŶ ƉƌŽƉ ƌĞƐŝnj

dƌĂŶƐŐĞŶĚĞƌ ;ƚƌĂŶƐͿ ŝŶĚŝǀŝĚƵĂůƐ ĂƌĞ ƚŚŽƐĞ ǁŚŽƐĞ ĂƐƐŝŐŶĞĚ ƐĞdž Ăƚ ďŝƌƚŚ ŝƐ ŝŶĐŽŶŐƌƵĞŶƚ ǁŝƚŚ ƚŚĞŝƌ ŝŶƚĞƌŶĂů ŐĞŶĚĞƌ ĂůŝŐŶŵĞŶƚ͘ dŚĞƐĞ ŝŶĚŝǀŝĚƵĂůƐ ĞdžƉĞƌŝĞŶĐĞ Ă ǀĂƌŝĞƚLJ ŽĨ ĚŝƐƉĂƌŝƚŝĞƐ ƌĞůĂƚĞĚ ƚŽ ŚĞĂůƚŚ ƐƵĐŚ ĂƐ ƉŽŽƌĞƌ ƌĞƉŽƌƚĞĚ ŵĞŶƚĂů ŚĞĂůƚŚ͕ ŝŶĐƌĞĂƐĞĚ ƌĂƚĞƐ ŽĨ ĂƐƚŚŵĂ͕ ŝŶĐƌĞĂƐĞĚ ƐŵŽŬŝŶŐ ƉƌĞǀĂůĞŶĐĞ͕ ĂŶĚ ǁŽƌƐĞ ŐĞŶĞƌĂů ƉŚLJƐŝĐĂů ǁĞůů ďĞŝŶŐ ĂĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ ϮϬϭϵ ĞŚĂǀŝŽƌĂů ZŝƐŬ &ĂĐƚŽƌ ^ƵƌǀĞŝůůĂŶĐĞ ^LJƐƚĞŵ ĚĂƚĂ͘ &Žƌ ŵŽƐƚ ŝŶĚŝǀŝĚƵĂůƐ͕ ŝŶĐůƵĚŝŶŐ ƚŚŝƐ ƉŽƉƵůĂƚŝŽŶ͕ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉŚLJƐŝĐŝĂŶƐ ƐĞƌǀĞ ĂƐ ƚŚĞ ĨŝƌƐƚ ĂdžŝƐ ŽĨ ĐĂƌĞ ĨŽƌ ŵŽƐƚ ŵĞĚŝĐĂů ĐŽŶĐĞƌŶƐ͕ ƉĂƌƚŝĐƵůĂƌůLJ ŝŶ ƌƵƌĂů ƐĞƚƚŝŶŐƐ͘ dƌĂŶƐŐĞŶĚĞƌ ƉĂƚŝĞŶƚƐ ĂƌĞ ŵŽƌĞ ůŝŬĞůLJ ƚŽ ďĞ ƵŶŝŶƐƵƌĞĚ ƚŚĂŶ ƚŚĞŝƌ ĐŝƐŐĞŶĚĞƌ ĐŽƵŶƚĞƌƉĂƌƚƐ͕ ĐŽŵƉŽƵŶĚŝŶŐ ƚŚĞ ƌĞƐƚƌŝĐƚĞĚ ĂĐĐĞƐƐ ƚŚĞƐĞ ƉĂƚŝĞŶƚƐ ĨĂĐĞ ǁŚĞŶ ƐĞĞŬŝŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ tŝƚŚ ƚŚĞƐĞ ĚŝƐƉĂƌŝƚŝĞƐ ĂŶĚ ƚŚĞ ĐƵƌƌĞŶƚ ĐůŝŵĂƚĞ ĂƌŽƵŶĚ ĂĐĐĞƐƐŝďŝůŝƚLJ ƚŽ ĐĂƌĞ ĨŽƌ ƚƌĂŶƐ ƉĂƚŝĞŶƚƐ͕ ŝƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞ ůŝŵŝƚĂƚŝŽŶƐ ĂŶĚ ďĂƌƌŝĞƌƐ ƚŽ ƉƌŝŵĂƌLJ ĐĂƌĞ ƚŚĂƚ ĞdžŝƐƚ ĨŽƌ ƚŚŝƐ ƉŽƉƵůĂƚŝŽŶ ƉĂƌƚŝĐƵůĂƌůLJ ŝŶ ƚŚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƐĞƚƚŝŶŐ͘ dŚŝƐ ƌĞǀŝĞǁ ǁĂƐ ĐŽŶĚƵĐƚĞĚ ĨƌŽŵ ůŝƚĞƌĂƚƵƌĞ ĂǀĂŝůĂďůĞ ŽŶ WƵďDĞĚ ƵŶĚĞƌ ƚŚĞ ŬĞLJǁŽƌĚ ƐĞĂƌĐŚ “transgender” AND “barriers to care” AND “family medicine” yielding 109 publications. Articles were reviewed by three ŝŶĚĞƉĞŶĚĞŶƚ ĐŽĚĞƌƐ LJŝĞůĚŝŶŐ ϰϳ ĞůŝŐŝďůĞ ĂƌƚŝĐůĞƐ͘ dŚĞ ƉƌĞůŝŵŝŶĂƌLJ ƌĞƐƵůƚƐ ŚŝŐŚůŝŐŚƚ ƚŚĞ ŝŵƉĂĐƚ ƚŚĂƚ ƉƌŽǀŝĚĞƌ ŬŶŽǁůĞĚŐĞ ŚĂƐ on patients desire to seek care as well as providers’ lack of confidence or willingness to provide care to this population. dŚƵƐ͕ ŝŶĚŝĐĂƚŝŶŐ Ă ĨƵƌƚŚĞƌ ĞdžĂĐĞƌďĂƚŝŽŶ ŽĨ ƚŚĞ ƉƌĞĚĞĨŝŶĞĚ ĚŝƐƉĂƌŝƚŝĞƐ ŝŶ ƚŚŝƐ ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƚŝŽŶ͘ dŽ ŝĚĞŶƚŝĨLJ ǁŚĂƚ ďĂƌƌŝĞƌƐ ĞdžŝƐƚ ĨŽƌ ƚƌĂŶƐŐĞŶĚĞƌ ŝŶĚŝǀŝĚƵĂůƐ ŝŶ ƚŚĞŝƌ ĂĐĐĞƐƐ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐĞƌǀŝĐĞƐ ŝŶ ƚŚĞ ĐƵƌƌĞŶƚ ůŝƚĞƌĂƚƵƌĞ ƉŽŽů͘

dĂďůĞ ϭ͗ dŚĞŵĂƚŝĐ ŶĂůLJƐŝƐ ZĞƐƵůƚƐ

Subcategory

Theme

Knowledge of needs of transgender patients (n=11)

Limited curriculum on transgender populations (n=11) Lack of exposure (n=1) Limited data on clinical decision making for transgender patients (n=1) Need to standardize care (n=2) Physician discomfort (n=6)

Lack of educational exposure for providers regarding transgender care

Physician - Patient comfort in interacting regarding the patient’s care

Patient discomfort (n=5) Physician-patient relationship (n=3) Transportation (n=2)

Geographic location (n=2) Infrastructure (n=4) Insurance/cost of care (n=4) Perceived relevance (n=2)

Accessibility

Need for emphasis on the relevance and importance of unique experiences of transgender patients

Willingness to buy into new curriculum (n=1) Unique needs of transgender patients (n=3)

dŚĞ ƐĞůĞĐƚĞĚ ĂƌƚŝĐůĞƐ ǁĞƌĞ ĚŝǀŝĚĞĚ ŝŶƚŽ ƉƌŽǀŝĚĞƌ ƉĞƌƐƉĞĐƚŝǀĞƐ and patient perspectives, then “codes” were established based ŽŶ ĨŝŶĚŝŶŐƐ ĨƌŽŵ ĞĂĐŚ ƐƚƵĚLJ͘ ĂƚĂ ǁĞƌĞ ĨƵƌƚŚĞƌ ƐƵďͲŐƌŽƵƉĞĚ ĂĐĐŽƌĚŝŶŐ ƚŽ ĞŵĞƌŐŝŶŐ ƚŚĞŵĞƐ͕ ĂƐ ĚĞŵŽŶƐƚƌĂƚĞĚ ŝŶ /ŵĂŐĞ Ϯ͘ Literature that did not distinguish “LGBTQIA+” populations and “transgender” populations were excluded to ensure that ƚŚĞ ƚĂƌŐĞƚ ƉĂƚŝĞŶƚ ƉŽƉƵůĂƚŝŽŶ ǁĂƐ ƉƌŽƉĞƌůLJ ƌĞĨůĞĐƚĞĚ͘ tĞ ĚŝĚ ŶŽƚ ĞdžĐůƵĚĞ ůŝƚĞƌĂƚƵƌĞ ƚŚĂƚ ǁĂƐ ĂŶĞĐĚŽƚĂů Žƌ ŽďƐĞƌǀĂƚŝŽŶĂů ŝŶ ŶĂƚƵƌĞ͕ ŐŝǀĞŶ ƚŚĞ ůŝŵŝƚĞĚ ƉŽŽů ŽĨ ĚĂƚĂ ŽŶ ƚŚĞ ƐƵďũĞĐƚ͘

• ĂƌƌŝĞƌƐ ƚŽ ĐĂƌĞ ĨŽƌ ƚƌĂŶƐŐĞŶĚĞƌ ƉĂƚŝĞŶƚƐ ŝƐ Ă ĐŽŵƉůĞdž ĂŶĚ ŝŶƚĞƌƐĞĐƚŝŽŶĂů ŝƐƐƵĞ ƉĞƌƚĂŝŶŝŶŐ ƚŽ ƚŚĞŵĞƐ ĂĐƌŽƐƐ ĞĚƵĐĂƚŝŽŶĂů͕ ƐŽĐŝĂů͕ ƉŽůŝƚŝĐĂů͕ ĂŶĚ ƉĞƌƐŽŶĂů ƐƉŚĞƌĞƐ͘ • ĚƵĐĂƚŝŽŶ ŝƐ Ă ŵĂũŽƌ ĐŽŶĐĞƌŶ ǁŚĞŶ ŝƚ ĐŽŵĞƐ ƚŽ ĐĂƌŝŶŐ ĨŽƌ ƚƌĂŶƐŐĞŶĚĞƌ ƉĂƚŝĞŶƚƐ͘ DŽƌĞ ĐƵƌƌŝĐƵůƵŵ͕ ĞdžƉŽƐƵƌĞ͕ ĂŶĚ ĐŽƵƌƐĞƐ ĂƌĞ ŶĞĞĚĞĚ ƚŽ ĂĚĚƌĞƐƐ ƚŚŝƐ ĐŽŶĐĞƌŶ͘ • WŽůŝĐLJ ƚŽ ĨĂĐŝůŝƚĂƚĞ ďĞƚƚĞƌ ĂǀĂŝůĂďŝůŝƚLJ ŽĨ ƉƌŽǀŝĚĞƌƐ͕ ĂĐĐĞƐƐ ƚŽ ƚƌĂŶƐƉŽƌƚĂƚŝŽŶ͕ ĂŶĚ ŝŵƉƌŽǀŝŶŐ ŝŶƐƵƌĂŶĐĞ ĐŽǀĞƌĂŐĞͬ ŵŝŶŝŵŝnjŝŶŐ ĐŽƐƚ ŽĨ ĐĂƌĞ ĂƌĞ ŶĞĞĚĞĚ ƚŽ ĂĚĚƌĞƐƐ ĐŽŵŵŽŶ ďĂƌƌŝĞƌƐ ƚŽ ĐĂƌĞ͘ • &ƵƚƵƌĞ ƌĞƐĞĂƌĐŚ ƐŚŽƵůĚ ĐĞŶƚĞƌ ĂƌŽƵŶĚ ƚŚĞ ŝŶƚĞƌƐĞĐƚŝŽŶĂů ŶĂƚƵƌĞ ŽĨ ďĂƌƌŝĞƌƐ ƚŽ ĐĂƌĞ ƚŽ ďĞƐƚ ĐƌĂĨƚ ŝŶƚĞƌǀĞŶƚŝŽŶƐ͘ • ĚƵĐĂƚŝŽŶĂů ŝŶƚĞƌǀĞŶƚŝŽŶƐ ĨŽƌ ƉŚLJƐŝĐŝĂŶƐ͕ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͕ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ŵĂLJ ďĞ ďĞŶĞĨŝĐŝĂů ŝŶ ĂĚĚƌĞƐƐŝŶŐ ƚŚĞ ŬŶŽǁůĞĚŐĞ ŐĂƉ ƚŚĂƚ ŝƐ ƌĞƉŽƌƚĞĚ ďLJ ďŽƚŚ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƉĂƚŝĞŶƚƐ ĂŶĚ ƉŽƚĞŶƚŝĂůůLJ ƐĞƌǀĞ ƚŽ ĂĚĚƌĞƐƐ ƵŶĐŽŶƐĐŝŽƵƐ ĂŶĚ ĐŽŶƐĐŝŽƵƐ ďŝĂƐĞƐ ƚŚĂƚ ĞdžŝƐƚ ĨŽƌ ŵĞĚŝĐĂů ƉƌŽǀŝĚĞƌƐ͘ • /ŶĐĞŶƚŝǀŝnjŝŶŐ ĐŽƐƚͲĐŽŶƐĐŝŽƵƐ ĐĂƌĞ ƉůĂŶƐ ĐĂŶ ŚĞůƉ ƚŽ ƌĞĚƵĐĞ ŵĞĚŝĐĂů ĐŽƐƚ ĂƐ Ă ďĂƌƌŝĞƌ ƚŽ ĐĂƌĞ͘ Discrimination (n=12) Socio-Political Support (n=2)

>ŝƚĞƌĂƚƵƌĞ ^ĞĂƌĐŚ ŽŶ WƵďDĞĚ “transgender barrier to care family medicine” (n=109)

ůŝŐŝďŝůŝƚLJ͗ ϭ͘ KƌŝŐŝŶĂů ZĞƐĞĂƌĐŚ Ϯ͘ dƌĂŶƐŐĞŶĚĞƌ ƉĂƚŝĞŶƚƐ ϯ͘ WƌŝŵĂƌLJ ĐĂƌĞ ƐĞƚƚŝŶŐ

/ŶĞůŝŐŝďůĞ͗ ŶсϲϮ

ůŝŐŝďůĞ͗ Ŷсϰϳ

/ŵĂŐĞ ϭ͘ >ŝƚĞƌĂƚƵƌĞ ^ĞůĞĐƚŝŽŶ

/ŵĂŐĞ Ϯ͘ dŚĞŵĂƚŝĐ ŶĂůLJƐŝƐ

ZĞĨĞƌĞŶĐĞƐ͗ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƚŝŽŶ ; Ϳ͘ ĞŚĂǀŝŽƌĂů ZŝƐŬ &ĂĐƚŽƌ ^ƵƌǀĞŝůůĂŶĐĞ ^LJƐƚĞŵ ^ƵƌǀĞLJ ĂƚĂ͘ ƚůĂŶƚĂ͕ 'ĞŽƌŐŝĂ͗ h͘ ^͘ ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂŶĚ ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ͕ ͕ ΀ϮϬϭϵ΁͘

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2024 Research Recognition Day