Virtual consults boost PCP comfort in providing gender-affirming care

Virtual care modality-enabled consultative support increased comfort among pediatric primary care providers (PCPs) in providing gender-affirming care, according to a recent study.

Gender-affirming care includes various supportive healthcare services, including medical, surgical, mental health, and non-medical services, for transgender and nonbinary people. However, gender-diverse youth experience multiple barriers to accessing this care in the United States. These include growing policy restrictions in several states and a lack of primary care physicians who feel they are equipped to provide gender-affirming care. In a 2018 survey, nearly 86 percent of clinicians were willing to provide routine care to transgender patients, but only 69 percent reported feeling capable of doing so.

The study published in the journal Telemedicine and e-Health assessed how specialist-to-pediatric PCP consultative support affects the latter’s comfort in providing gender-affirming care.

The researchers surveyed 51 pediatric PCPs across West Virginia from winter 2021 through spring 2022. In addition to assessing whether consultative support would increase their comfort in providing various aspects of gender-affirming care, such as referring to affirming behavioral health providers and providing medications, the survey evaluated what consultation modalities PCPs felt would be most helpful in supporting them.

They examined four consultation modalities: tele-education/ECHO, in which groups of community providers virtually connect with a team of specialists for regular, real-time collaborative sessions; electronic consultation, in which PCP-to-specialist communication is facilitated via a shared EHR or another web-based platform; telephone consultation, in which PCPs and specialists consult via telephone calls; and telemedicine consultations, in which the patient is seen by a gender specialist via audio-video technology while in the PCP’s clinic.

Of the 51 PCPs who completed the survey, 47.1 had less than 10 years of experience, and 54.9 percent had more than 10. More than half (59.6 percent) had received specialty training in pediatrics and 40.4 percent in family medicine. They reported seeing a mean of 5.3 gender-diverse youth in their practice in the prior year.

On average, pediatric PCPs agreed that having access to consultative support would help them feel more comfortable providing this care. Comfort scores for consultative support were highest for connecting gender-diverse youth with affirming behavioral health providers and lowest for initiating gender-affirming medications.

However, pediatric PCPs with fewer than 10 years of experience were more likely to agree that access to consultative support would make them more comfortable providing gender-affirming care compared to those with more than 10. Similarly, those trained in pediatrics were more likely to agree with the above statement than those trained in family medicine.

Further, the participating PCPs gave each consultation modality high comfort scores; however, they ranked telemedicine consultation as the most practical method and tele-education/ECHO as the least practical.

“In conclusion, specialist-PCP consultative support modalities show great promise in increasing [pediatric] PCP comfort caring for GDY [gender-diverse youth] in the primary care setting,” the researchers wrote. “This may be especially important for rural [pediatric] PCPs, whose patients may be more likely to experience geographic and travel-related barriers to receiving this care in specialty settings.”

The study adds to previous research showing how telehealth adoption can bolster gender-affirming care access.

A study published in March showed that telehealth was linked to lower no-show rates among transgender and gender-diverse youth in rural areas. The researchers conducted a retrospective analysis of EMR data from a clinic serving transgender and gender-diverse adolescents and young adults. They analyzed 17,928 patient encounters for 2,908 unique individuals from March 2020 to December 2021. Of these, 4,917 (27.4 percent) were conducted via telehealth.

Overall, the no-show rate for the 17,928 patient encounters was 10.9 percent. However, telehealth visits had a no-show rate of only 5.4 percent. The study further shows gender health-related visits had a lower no-show rate (6.5 percent) than non-gender health visits (11.1 percent).