Walking the walk

 

In March 2018, the Human Rights Campaign (HRC), an advocacy organization dedicated to improving the lives of LGBTQ people, released its 11th Annual Healthcare Equality Index. The HEI is an indicator of how inclusive and equitable health care facilities are in providing care for their LGBTQ patients. My own institution, Children’s Hospital of Pittsburgh, scored very high on this index and received the “Leader in LGBTQ Healthcare Equality” designation. The process of receiving this designation is very rigorous, and I am proud of my institution for making great strides in expanding health care access for LGBTQ patients, especially transgender patients. However, this is no time to rest on one’s laurels, as many transgender people still experience challenges and barriers in navigating the health care system.

AlexRaths/Thinkstock

Disparities in health outcomes between transgender and nontransgender people is well known, and some of these discrepancies can be attributed to difficulty in accessing high-quality health care. The biggest barrier is finding a health care provider who is culturally competent in delivering health care to transgender patients. Many transgender individuals expect rejection and discrimination everywhere they go,¹ and health care institutions are no exception. For example, about one-fifth of transgender individuals report being denied health care at their primary care provider because of the person’s gender identity and/or gender expression.² Even if they’re not rejected outright, many transgender patients often are misgendered by health care staff, or they find themselves educating the provider on transgender health issues.² Even transgender individuals who find a provider who is competent in providing transgender health care still experience additional barriers. For example, EHRs often do not list gender identity and/or pronouns in the chart. This makes it more likely for providers to misgender patients by mistake because they only have the EHR as a reference.

Insurance access continues to be a problem. I wrote a column in June 2017 about obtaining health care insurance for transgender patients. Preauthorization is common for obtaining cross-sex hormones or pubertal blockers even for insurance companies that are willing to pay for them – a process that can take weeks, even months, to complete. This creates delays in obtaining necessary care for transgender patients. This is just one of the many barriers transgender people face in navigating the health care system.

Increasing access to health care services for transgender patients is more about improving health outcomes than patient satisfaction. Even the smallest policy change may have a meaningful impact on the lives of transgender individuals. A study by Russell et al., in the April 2018 issue of Journal of Adolescent Health found that transgender youth allowed to use their chosen name (instead of the name assigned to them by their parents at birth) were more likely to have fewer depressive symptoms and lower rates of suicidal ideation and suicidal behavior.³ These findings highlight that even a small change can have a huge impact on the health and well-being of this patient population.

 

What can you do to expand access? First, you must educate yourself and teach others. Many providers report never having received education on LGBTQ health during their training,⁴ and most barriers for transgender patients stem from this lack of training. Second, work with the transgender community – it is very tempting to see your institution’s name on the HEI and think all the work is done, but the lived experiences of transgender patients sometimes are different than what is seen on paper (or online). Team up with local organizations such as PFLAG (formerly known as Parents and Families of Lesbians and Gays) that can create support groups for both transgender youth and their families. Help create a network of referral systems for your transgender patients – the community is often small enough that they know which providers or establishments are safe for transgender individuals. Many transgender patients find this extremely helpful.⁵ You still wield significant influence in the community, so work with the health care and insurance systems to improve access and coverage for gender-related services. The HRC HEI is becoming coveted by health care institutions. This is a prime opportunity to be involved in committees seeking to improve health care access for transgender individuals. Finally, as there are champions for transgender health in your clinic, there also are champions for transgender health in insurance companies. They often are well known in the community, so find that individual for counseling on how to navigate the insurance system for your transgender patients.

Although an increasing number of health care institutions and clinics are recognizing the health care needs of transgender patients and providing appropriate care, the health care system remains challenging for transgender individuals to navigate. Small policy changes may have a substantial impact on the health and well-being of transgender individuals. Although creating change within an institution may seem like a monumental task, you do have the agency to help create this type change within the system to expand health care access for transgender patients.

Dr. Montano is an assistant professor of pediatrics at the University of Pittsburgh and an adolescent medicine physician at Children’s Hospital of Pittsburgh of UPMC. Email him at [email protected].

 

Resources

• HRC HEI: If you’re interested in learning what policies are inclusive and equitable for LGBT patients, check out the HRC HEI scoring criteria. It’s a good place to start if you want to expand health care access for transgender individuals.
• To find out more about the health care legal protections transgender individuals are entitled to, check out the National Center for Transgender Equality.

References

1. Psychol Bull. 2003 Sep;129(5):674-97.

2. “Injustice at every turn: A report of the National Transgender Discrimination Survey.” (Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.)

3. J. Adolesc Health. 2018 Apr. doi: 10.1016/j.jadohealth.2018.02.003.

4. Int J Transgenderism. 2008. doi: 10.1300/J485v08n02_08.

5. Transgend Health. 2016 Nov 1;1(1):238-49.

 

In March 2018, the Human Rights Campaign (HRC), an advocacy organization dedicated to improving the lives of LGBTQ people, released its 11th Annual Healthcare Equality Index. The HEI is an indicator of how inclusive and equitable health care facilities are in providing care for their LGBTQ patients. My own institution, Children’s Hospital of Pittsburgh, scored very high on this index and received the “Leader in LGBTQ Healthcare Equality” designation. The process of receiving this designation is very rigorous, and I am proud of my institution for making great strides in expanding health care access for LGBTQ patients, especially transgender patients. However, this is no time to rest on one’s laurels, as many transgender people still experience challenges and barriers in navigating the health care system.

AlexRaths/Thinkstock

Disparities in health outcomes between transgender and nontransgender people is well known, and some of these discrepancies can be attributed to difficulty in accessing high-quality health care. The biggest barrier is finding a health care provider who is culturally competent in delivering health care to transgender patients. Many transgender individuals expect rejection and discrimination everywhere they go,¹ and health care institutions are no exception. For example, about one-fifth of transgender individuals report being denied health care at their primary care provider because of the person’s gender identity and/or gender expression.² Even if they’re not rejected outright, many transgender patients often are misgendered by health care staff, or they find themselves educating the provider on transgender health issues.² Even transgender individuals who find a provider who is competent in providing transgender health care still experience additional barriers. For example, EHRs often do not list gender identity and/or pronouns in the chart. This makes it more likely for providers to misgender patients by mistake because they only have the EHR as a reference.

Insurance access continues to be a problem. I wrote a column in June 2017 about obtaining health care insurance for transgender patients. Preauthorization is common for obtaining cross-sex hormones or pubertal blockers even for insurance companies that are willing to pay for them – a process that can take weeks, even months, to complete. This creates delays in obtaining necessary care for transgender patients. This is just one of the many barriers transgender people face in navigating the health care system.

Increasing access to health care services for transgender patients is more about improving health outcomes than patient satisfaction. Even the smallest policy change may have a meaningful impact on the lives of transgender individuals. A study by Russell et al., in the April 2018 issue of Journal of Adolescent Health found that transgender youth allowed to use their chosen name (instead of the name assigned to them by their parents at birth) were more likely to have fewer depressive symptoms and lower rates of suicidal ideation and suicidal behavior.³ These findings highlight that even a small change can have a huge impact on the health and well-being of this patient population.

 

What can you do to expand access? First, you must educate yourself and teach others. Many providers report never having received education on LGBTQ health during their training,⁴ and most barriers for transgender patients stem from this lack of training. Second, work with the transgender community – it is very tempting to see your institution’s name on the HEI and think all the work is done, but the lived experiences of transgender patients sometimes are different than what is seen on paper (or online). Team up with local organizations such as PFLAG (formerly known as Parents and Families of Lesbians and Gays) that can create support groups for both transgender youth and their families. Help create a network of referral systems for your transgender patients – the community is often small enough that they know which providers or establishments are safe for transgender individuals. Many transgender patients find this extremely helpful.⁵ You still wield significant influence in the community, so work with the health care and insurance systems to improve access and coverage for gender-related services. The HRC HEI is becoming coveted by health care institutions. This is a prime opportunity to be involved in committees seeking to improve health care access for transgender individuals. Finally, as there are champions for transgender health in your clinic, there also are champions for transgender health in insurance companies. They often are well known in the community, so find that individual for counseling on how to navigate the insurance system for your transgender patients.

Although an increasing number of health care institutions and clinics are recognizing the health care needs of transgender patients and providing appropriate care, the health care system remains challenging for transgender individuals to navigate. Small policy changes may have a substantial impact on the health and well-being of transgender individuals. Although creating change within an institution may seem like a monumental task, you do have the agency to help create this type change within the system to expand health care access for transgender patients.

Dr. Montano is an assistant professor of pediatrics at the University of Pittsburgh and an adolescent medicine physician at Children’s Hospital of Pittsburgh of UPMC. Email him at [email protected].

 

Resources

• HRC HEI: If you’re interested in learning what policies are inclusive and equitable for LGBT patients, check out the HRC HEI scoring criteria. It’s a good place to start if you want to expand health care access for transgender individuals.
• To find out more about the health care legal protections transgender individuals are entitled to, check out the National Center for Transgender Equality.

References

1. Psychol Bull. 2003 Sep;129(5):674-97.

2. “Injustice at every turn: A report of the National Transgender Discrimination Survey.” (Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.)

3. J. Adolesc Health. 2018 Apr. doi: 10.1016/j.jadohealth.2018.02.003.

4. Int J Transgenderism. 2008. doi: 10.1300/J485v08n02_08.

5. Transgend Health. 2016 Nov 1;1(1):238-49.

 

In March 2018, the Human Rights Campaign (HRC), an advocacy organization dedicated to improving the lives of LGBTQ people, released its 11th Annual Healthcare Equality Index. The HEI is an indicator of how inclusive and equitable health care facilities are in providing care for their LGBTQ patients. My own institution, Children’s Hospital of Pittsburgh, scored very high on this index and received the “Leader in LGBTQ Healthcare Equality” designation. The process of receiving this designation is very rigorous, and I am proud of my institution for making great strides in expanding health care access for LGBTQ patients, especially transgender patients. However, this is no time to rest on one’s laurels, as many transgender people still experience challenges and barriers in navigating the health care system.

AlexRaths/Thinkstock

Disparities in health outcomes between transgender and nontransgender people is well known, and some of these discrepancies can be attributed to difficulty in accessing high-quality health care. The biggest barrier is finding a health care provider who is culturally competent in delivering health care to transgender patients. Many transgender individuals expect rejection and discrimination everywhere they go,¹ and health care institutions are no exception. For example, about one-fifth of transgender individuals report being denied health care at their primary care provider because of the person’s gender identity and/or gender expression.² Even if they’re not rejected outright, many transgender patients often are misgendered by health care staff, or they find themselves educating the provider on transgender health issues.² Even transgender individuals who find a provider who is competent in providing transgender health care still experience additional barriers. For example, EHRs often do not list gender identity and/or pronouns in the chart. This makes it more likely for providers to misgender patients by mistake because they only have the EHR as a reference.

Insurance access continues to be a problem. I wrote a column in June 2017 about obtaining health care insurance for transgender patients. Preauthorization is common for obtaining cross-sex hormones or pubertal blockers even for insurance companies that are willing to pay for them – a process that can take weeks, even months, to complete. This creates delays in obtaining necessary care for transgender patients. This is just one of the many barriers transgender people face in navigating the health care system.

Increasing access to health care services for transgender patients is more about improving health outcomes than patient satisfaction. Even the smallest policy change may have a meaningful impact on the lives of transgender individuals. A study by Russell et al., in the April 2018 issue of Journal of Adolescent Health found that transgender youth allowed to use their chosen name (instead of the name assigned to them by their parents at birth) were more likely to have fewer depressive symptoms and lower rates of suicidal ideation and suicidal behavior.³ These findings highlight that even a small change can have a huge impact on the health and well-being of this patient population.

 

What can you do to expand access? First, you must educate yourself and teach others. Many providers report never having received education on LGBTQ health during their training,⁴ and most barriers for transgender patients stem from this lack of training. Second, work with the transgender community – it is very tempting to see your institution’s name on the HEI and think all the work is done, but the lived experiences of transgender patients sometimes are different than what is seen on paper (or online). Team up with local organizations such as PFLAG (formerly known as Parents and Families of Lesbians and Gays) that can create support groups for both transgender youth and their families. Help create a network of referral systems for your transgender patients – the community is often small enough that they know which providers or establishments are safe for transgender individuals. Many transgender patients find this extremely helpful.⁵ You still wield significant influence in the community, so work with the health care and insurance systems to improve access and coverage for gender-related services. The HRC HEI is becoming coveted by health care institutions. This is a prime opportunity to be involved in committees seeking to improve health care access for transgender individuals. Finally, as there are champions for transgender health in your clinic, there also are champions for transgender health in insurance companies. They often are well known in the community, so find that individual for counseling on how to navigate the insurance system for your transgender patients.

Although an increasing number of health care institutions and clinics are recognizing the health care needs of transgender patients and providing appropriate care, the health care system remains challenging for transgender individuals to navigate. Small policy changes may have a substantial impact on the health and well-being of transgender individuals. Although creating change within an institution may seem like a monumental task, you do have the agency to help create this type change within the system to expand health care access for transgender patients.

Dr. Montano is an assistant professor of pediatrics at the University of Pittsburgh and an adolescent medicine physician at Children’s Hospital of Pittsburgh of UPMC. Email him at [email protected].

 

Resources

• HRC HEI: If you’re interested in learning what policies are inclusive and equitable for LGBT patients, check out the HRC HEI scoring criteria. It’s a good place to start if you want to expand health care access for transgender individuals.
• To find out more about the health care legal protections transgender individuals are entitled to, check out the National Center for Transgender Equality.

References

1. Psychol Bull. 2003 Sep;129(5):674-97.

2. “Injustice at every turn: A report of the National Transgender Discrimination Survey.” (Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.)

3. J. Adolesc Health. 2018 Apr. doi: 10.1016/j.jadohealth.2018.02.003.

4. Int J Transgenderism. 2008. doi: 10.1300/J485v08n02_08.

5. Transgend Health. 2016 Nov 1;1(1):238-49.