Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices

PURPOSE:

Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities.

METHODS:

We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps.

RESULTS:

Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents.

CONCLUSIONS:

This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented.

...Summit participants pointedly appealed for “realistic action steps” that could lead to “immediate improvements” for LGBTQ patient-centered care:

• Create a safe, welcoming environment
• Post LGBTQ-positive visual representations, for example, images of people/families of differing gender/sexual, cultural, ethnic/racial backgrounds, in lobbies/examination rooms
• Use culturally appropriate, culturally specific terms on intake forms; that is, recognize that some patients may prefer local terminologies such as Native American use of “Two-Spirit,” patient preference for “queer” over “lesbian,” “gay” or “bisexual,” and/or use of “they” as a preferred gender pronoun by people across the sexual/gender minority spectrum
• Include gender/sexual difference in displayed antidiscrimination policies

Develop culturally competent medical staff

• Invite local LGBTQ community members/leaders to clinic meetings to discuss the experiences/treatment needs of LGBTQ patients
• Encourage respectful, direct, open-ended questions using culturally relevant terminology in provider–patient interactions regarding identity, sexual history, and risk factors
• Use local university/community-based safe zone training¹⁵ centered on how to be an LGBTQ ally while enhancing understanding of anti-LGBTQ stigma/phobias and microaggressions for all providers and staff to encourage patient feelings of security

Update medical training

• Deploy technologies in rural settings, for example, video/Web conferencing for consulting LGBTQ specialists
• Acquire information on LGBTQ-specific health, for example, hormone therapies and associated risks for transgender patients, gender-sensitive cancer screenings
• Participate in research to improve LGBTQ health care

Full article at:   http://goo.gl/ujDiCq

By:  Kano M1, Silva-Bañuelos AR2, Sturm R2, Willging CE2.

• 1From the Department of Family and Community Medicine, University of New Mexico, Albuquerque (MK); the University of New Mexico LGBTQ Resource Center (http://lgbtqrc.unm.edu/), Albuquerque (ARS-B); the New Mexico Community AIDS Partnership, Santa Fe (RS); and the Pacific Institute for Research and Evaluation, Behavioral Health Research Center of the Southwest, Albuquerque, NM (CEW). mkano@salud.unm.edu.
• 2From the Department of Family and Community Medicine, University of New Mexico, Albuquerque (MK); the University of New Mexico LGBTQ Resource Center, Albuquerque (ARS-B); the New Mexico Community AIDS Partnership, Santa Fe (RS); and the Pacific Institute for Research and Evaluation, Behavioral Health Research Center of the Southwest, Albuquerque, NM (CEW). 

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