Abstract: Factors Associated with Trans Women's Recency of Last Visit with a Primary Care Physician: Implications for Social Work Research and Practice (Society for Social Work and Research 29th Annual Conference)

Schedule:

Saturday, January 18, 2025

Medina, Level 3 (Sheraton Grand Seattle)

* noted as presenting author

Gabi Celia Ortiz, PhD Candidate, Boston College

Ashley Lacombe-Duncan, PhD, Associate Professor, University of Michigan-Ann Arbor, Ann Arbor, MI

Becca Emrick, MSW, Research Coordinator, University of Michigan-Ann Arbor

Angela Underhill, Research Manager, Women's College Hospital, ON, Canada

Pierre Côté, Physician and Researcher, Clinique de Médecine Urbaine du Quartier Latin

Luke T Kyne, Research Assistant, Women's College Hospital, ON, Canada

Amir A Besharati, Research Assistant, Clinique de Médecine Urbaine du Quartier Latin, QC, Canada

Ian Armstrong, Physician, Maple Leaf Medical Clinic, ON, Canada

Raymond Fung, Endocrinologist, Michael Garron Hospital, ON, Canada

LY Louie Chan, Physician, University of Toronto, ON, Canada

Thea Weisdorf, Physician, St. Michael’s Hospital, ON, Canada

Mona Loutfy, MPH, MD, FRCPC, MPH, Professor, University of Toronto & Maple Leaf Medical Clinic, Toronto, ON, Canada

Background and Purpose: Access to gender-affirming care through primary care physicians (PCPs) is essential for the well-being of transgender (trans) and gender diverse people. Despite similar needs for primary and preventative healthcare among trans and cisgender populations, there is a notable discrepancy in healthcare accessibility for trans women due to stigma, which may contribute to a lack of uptake of preventative and routine healthcare. While the body of literature based on the United States (U.S.) context has been increasing, less is known about trans women’s access of PCPs in Canada, a country with “universal” healthcare coverage – at least in terms of financial coverage. Thus, among trans women in Canada we sought to characterize: 1) recency of last visit with one’s PCP; and, 2) sociodemographic, clinical, and social/structural factors associated with recency of last visit with one’s PCP.

Methods: Utilizing data from the charts of 900 trans women aged 16+ enrolled in care in six primary care clinics in the Montreal Toronto Trans Study (MTTS), collected 2018-2019, we conducted bivariate and multivariate analyses using ordinal logistic regression analyses to determine sociodemographic (e.g., age), clinical (e.g., mental health history), and social/structural (e.g., source of income) factors associated with recency of last visit with their PCP (<1 year ago; ≥ 1 year and <3 years ago; ≥ 3 years ago). Analyses were conducted with STATA (version 18).

Results: Participants [mean age: 38 (SD= 13.94)] had an average time since last PCP visit of 2.09 years (SD =0.97), with 43% having had a PCP visit within the past year, 5% having had a PCP visit ≥ 1 year and <3 years ago and 52% having had a PCP visit ≥ 3 years ago. The average number of missed PCP visits within the last two years was 2.32 (SD=0.87). Bivariate analyses showed that having a mental health diagnosis was associated with 25% lower odds of having not had a PCP visit within the past year (OR: 0.75, 95% CI: 0.57, 0.99, p=0.04). In a multivariate model including all sociodemographic, clinical, and social/structural factors, only age was significant, such that for each additional year of age, the odds of having not had a PCP visit within the past year rose by 6% (OR: 1.06, 95% CI: 1.00, 1.12, p=0.05).

Conclusions: Our findings show that a concerning proportion - more than half - of trans women enrolled with a PCP had not seen them in the past three years. Findings should be contextualized within data limitations (e.g., patients may have moved and/or passed away). The negative association between PCP visits and advancing age was counterintuitive and should be further explored. Mental health-related primary care appointments may serve as opportunities for integrated preventative and gender-affirming healthcare with trans women. Future prospective studies may opt to collect variables related to transphobia and intersecting stigma as well as more comprehensive social/structural data (e.g., homelessness) to inform a deeper understanding of barriers to trans women’s uptake of primary care and potential solutions (e.g., provider training).