Abstract: Primary Care Providers' Willingness to Provide Routine Care to Transgender Individuals (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Schedule:

Saturday, January 14, 2017: 8:00 AM

Preservation Hall Studio 9 (New Orleans Marriott)

* noted as presenting author

Deirdre A. Shires, PhD, Na, Michigan State University, Detroit, MI

Daphna Stroumsa, MD, MPH, Medical Resident, Henry Ford Health System, Detroit, MI

Kim D. Jaffee, MSW, PhD, Associate Professor, Wayne State University, Detroit, MI

Michael Woodford, PhD, Associate Professor, Wilfrid Laurier University, Kitchener, ON

Purpose

Transgender individuals often report having negative experiences when seeking healthcare, including being denied basic or routine services. However, little is known about the barriers that healthcare providers face when treating this population. We examine whether professional factors, personal or clinical exposure to transgender individuals, and perceptions of knowledge or capability are associated with primary care providers’ willingness to provide routine care for transgender patients.

Methods

A cross-sectional design was used. Eligible participants were family medicine, internal medicine, and obstetric/gynecology providers (medical residents, attending physicians, and advanced practitioners) practicing in a large, integrated health system. Participants completed an online questionnaire in Fall 2015. Those who completed the survey were mailed a $30 gift card.

Results

Participants (n=223, 57% response rate) were mostly internal medicine or family medicine (IM/FM) providers (73.1%); 47.5% were attending physicians and 42.2% were residents. Most participants had met a transgender person (77.9%) and 50.2% had cared for at least one transgender patient in the past 5 years.

Most participants (62.4%) felt capable of providing routine care to transgender patients, and they reported an average of 2 knowledge-related barriers (e.g., lack of familiarity with guidelines for transition care for transgender patients; range = 0-4, SD = 1.6). Approximately three-fourths of participants were willing to provide primary care to transgender patients.

Multivariate adjusted binary logistic regression results suggest that the odds of willingness to provide routine care to transgender patients were lower among general women’s health providers compared to IM/FM providers (AOR=0.22, p=.018) and lower among attending physicians compared to residents (AOR=0.16, p=.020). Participants who reported feeling capable of providing routine care to transgender patients were over 13 times more likely to be willing to care for this population (AOR=13.26, p<.001). Perceived knowledge barriers did not significantly contribute to the model (AOR=1.15, p=.456).

Implications

Nearly one quarter of primary care providers (22%) were not willing to provide routine care to transgender patients. Feeling capable of providing routine care to transgender patients was the strongest predictor of willingness to provide such care. Because perceived knowledge-related barriers were not a significant predictor of willingness, the relationship between feelings of capability and willingness may be explained by a lack of non-medical knowledge among providers (for example, knowing how to interact with a transgender person in a culturally competent way, knowing how to assess the correct pronoun to use, etc.). Primary care providers may feel more willing and capable when part of care teams that include social workers. Future research should explore what factors contribute to feelings of capability among primary care providers and how both feelings of capability and willingness can be increased.