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Care of the transgender patient in the ed

Care of the transgender patient in the ed

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Care of the transgender patient in the ed

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  1. Care of the transgender patient in the ed Patrick finan, md pgy-1

  2. Roadmap • Definitions are tricky • Healthcare Inequities • Physicians: What do we know? • Patients: What physicians don’t know • Where can we go from here?

  3. Healthcare inequities- lgbt population • LGBT individuals overall: • Risk factors for poorer health • Mental health issues • Access to care

  4. Healthcare inequities 1 million adults in the US identify as transgender From 2009-2014, 2,351 transgender patients were diagnosed with HIV in the US. 2013 report: % transgender women with HIV in the United States was 22% among 2,705 transgender women sampled.

  5. Healthcare inequities transgender population 2011 National Center for Transgender Equality: • Suicide • Physical assault • Sexual assault • Hate crimes Disparities exacerbated by psychosocial factors

  6. Access to care 2010 Lambda Legal Survey • Financial barriers to receiving care • Poverty • Health insurance • Most pronounced with people of color (POC) • Injustice by healthcare system

  7. Access to care Difficulties using insurance related to gender identity, expression Coverage for transition surgery, hormonal therapies Access to routine care

  8. CBC and its partners are pursuing a high-impact prevention approach to maximize the effectiveness of current HIV prevention methods among transgender people, including - awarding $11 million/yr 2017-2022 to community-based organizations (CBOs) to provide HIV testing to young gay and bisexual men and young transgender people of color - Supporting projects that provide pre-exposure prophylaxis (PrEP) support services and data-to- care activities prioritizing MSM, transgender women (esp POC).

  9. What physicians know, think and do Annals of Emergency Medicine 2018 2015 national survey of 27,715 transgender and gender non-conforming adults as well as web-based surveys distributed to ACEP EM practice-based research network EMPRN - majority reported not receiving formal training - many cared for these patients

  10. What Phyisicians know, think and do Of the small number of ED physicians having received medical training, few answered questions correctly. - asking about pronoun use, asking about gender affirming surgeries - Unnecessary sensitive exams - medical knowledge re: common medications and surgeries in this population

  11. What physicians know, think and do EM training programs averaged 45 minutes last year on LGBT health 26% of EM residency programs presented a specific LGBT lecture. 33% incorporated topics on LGBT health into their curricula. Association between known LGBT faculty and precious presentation of any LGBT didactics

  12. What people are experiencing Annals of Emergency Medicine 2018 Survey of transgender individuals in Rhode Island with individual focus groups for discussions - Visited RI Emergency Department in past 5 yrs - Age > 18 - transgender/gender variant, genderqueer, intersex 43.8% avoided ED whe needing acute care (fear of discrimination, length of wait, negative previous experience, use of PCP)

  13. What people are experiencing- system structure System Structure: • Lack of privacy • Repetitive questioning • Repeated assertion of gender identity • Repeated need to educate

  14. Care competency Providers perceived as not knowing how and when to ask about gender identity, relevance to visit All patients need to be asked about what name they prefer, their gender identity and preferred pronouns

  15. What we can do next World Professional Association for Transgender Health advocates two-step process to collect sex and gender information • Biological sex • Gender identity

  16. What we can do next • Triage vs in-room communication • Gender-neutral bathrooms • Gender-neutral language when asking about sexual and relationship history • Symbols of being LGBT friendly • Rainbow stickers • Medical pins • Safe space identifiers

  17. references