Closing LGBTQ care gaps with self-reported SOGI data
A specialty clinic in California is advancing LGBTQ care through a digital tool that allows patients to self-report sensitive information, including SOGI data.
Sexual orientation and gender identity data is critical to closing care gaps across the LGBTQ population. However, patients are not always comfortable sharing SOGI details with providers for several reasons, including fear of discrimination.
According to a 2024 KFF report, LGBTQ adults are twice as likely as non-LGBTQ adults to report negative experiences while receiving healthcare over the last three years.
The CARE Center at Dignity Health-St. Mary Medical Center in Long Beach, California, has seen this firsthand as a specialty clinic serving mostly LGBTQ patients.
"85% of our patients are LGBTQ," said Paul Lovely, executive director of the CARE Center. "Many of them have had various problems or barriers with healthcare providers and staff who don't understand or aren't responsive to their needs."
To help ease patient discomfort in disclosing personal information, including SOGI and sexual health practices, the CARE Center adopted a digital tool for patients to self-report data.
Streamlining data collection
Using the tool from health IT vendor Phreesia, the clinic sends patients links to previsit questionnaires. After answering a few security questions, patients can digitally complete the questionnaire from their smartphones before their next appointment.
If a patient does not have a smartphone, front office staff can give patients a tablet to complete questionnaires upon arrival at the clinic.
Lovely said uptake of the digital tool is high, with about three-quarters of the clinic's patients self-reporting data regularly.
In addition to giving patients a discrete way to share sensitive information, self-reported data can help ensure that providers address all patient needs.
For instance, screening for anxiety and depression is critical to flag mental health concerns across LGBTQ patients. According to Census Bureau data, LGBTQ populations face more mental health challenges than non-LGBTQ individuals, underscoring the need for regular mental health assessments.
In addition to giving patients a discrete way to share sensitive information, self-reported data can help ensure that providers address all patient needs.
However, suppose a patient is not presenting outward symptoms of depression. In that case, a provider might forget to screen the patient for mental health during a visit, especially if they are addressing several other health concerns.
Using the digital tool, the CARE Center sends out anxiety and depression screenings to patients every three months. Self-reported data integrates with the clinic's EHR for easy access during patient visits.
Lovely noted that by having patients complete mental health screenings before their clinic visits, providers have one less thing they must remember to do during patient appointments.
In addition to flagging anxiety and depression concerns, the questionnaire can help facilitate conversations regarding social determinants of health, he added.
For instance, a patient might disclose to a provider that they are experiencing anxiety due to housing or food insecurity. The doctor can then refer them to an onsite benefits counselor who can assist them in accessing social services.
"Having that questionnaire can open a lot of conversations and help us to address those problems," Lovely emphasized.
Since the implementation of the tool, the CARE Center has digitally collected over 11,500 patient-reported outcomes.
Appointment reminders
In addition to self-reported data, the technology allows the clinic to send out appointment reminder texts and calls.
Lovely pointed out that while patient retention is important for all populations, it is especially critical for LGBTQ patients due to the public health dimension of caring for this population.
"We want our patients who are HIV-positive to get on meds as quickly as possible so that they can get the undetectable viral load, be healthy, but also so they don't transmit HIV to anyone else," Lovely said.
Patient retention is also critical for individuals who receive PrEP services to ensure medication adherence, as PrEP becomes much less effective when taken irregularly.
"You can set up the cadence of those appointment reminder texts and calls specifically depending on what kind of visit they have," Lovely said.
For instance, the clinic offers long-acting injectables for HIV-positive and PrEP patients. These medications can be a convenient treatment option as patients only receive the injectable once every two months.
However, patients must receive their next dose within five to seven days of the two-month mark to ensure proper medication levels in their system for effective HIV treatment or prevention.
"That's where those appointment reminders and being able to tailor those for each different group of patients is really important," Lovely underscored.
The health IT also allows the clinic to send check-in texts three days after patients start new medications.
"Especially when people are new to the clinic, they might be shy about reaching out to us even if they are having side effects," Lovely said. "Also, if there's a problem with the pharmacy or prior authorization, whatever it is, we want the patient to be able to let us know."
By implementing follow-up texts, the clinic can swiftly address any issues that arise, ensuring that patients remain on track with their treatment plans and feel supported throughout their healthcare journey.
"We take a lot of pride in giving the best quality care available, so we need all the tools we can get to help make sure we deliver that to our patients," Lovely said.
Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.
