they did not meet all criteria for rigorous development, dissemination, or were not specific for primary care. GLMA (2006) developed guidelines to guide the healthcare of LGBTQ people. This course has discussed some of the general recommendations for creating a welcoming, nonjudgmental environment and incorporating intake and sexual history forms that provide more inclusive and open-ended questions. GLMA recommends discussing patient confidentiality and developing a written statement to explain how their information is protected, how it remains confidential, who can access it, and what circumstances may require sharing of information. The preventive care topics are no different than for any client and, as always, we must take the time to determine which is a specific risk for each patient. Each new patient visit should assess sexual risk, safety related to lifestyle (seatbelts, firearms, sunblock), domestic violence, and substance use. As many as 45% of lesbian and bisexual women are not out to their providers, which reinforces the need to obtain a nonjudgmental sexual history and reinforcing confidentiality. GLMA identify risk factors for lesbian and bisexual women as being primarily social and behavioral. These include stress and failure to seek care, being overweight, as well as smoking and substance use. Completing screening for substance use, interpersonal violence, depression, and anxiety are important to identify these possible risks. Consideration should be given for breast cancer screening at age 40 in women who have not had children or experienced early menarche, and in those with a positive family history. Do not assume a lesbian or bisexual
woman does not plan to have children. Pap smears should be completed on all individuals with a uterus, including HPV testing at the recommended intervals, since transmission of HPV can occur among WSW. Additional screening and health concerns should be age appropriate and focused on actual behaviors of each client. Gay and bisexual men should receive the same screenings as any male (i.e., colon, prostate, and testicular cancers; coronary artery disease) with consideration for the increased risk of anal HPV, anal cancer, domestic violence, mental health issues, and substance use (GLMA, 2006). Healthcare for transgender individuals has been lacking in much of the US because of the insufficient number of healthcare providers with adequate training, discrimination or negative behaviors experienced during healthcare utilization, and insufficient insurance or ability to pay for care (Lerner & Robles, 2017; Nurse Practitioners in Women’s Health [NPWH], 2018). Screening should be based on anatomy and behaviors that are present. Cervical and prostate screenings, for anyone with a cervix or prostate respectively, should be conducted at recommended intervals for trans and cisgender individuals. Transgender men may experience anxiety or distress during pelvic examinations, and healthcare providers should be sensitive to this and attempt to maximize comfort during the examination (NPWH, 2018). Likewise, mammography is recommended for transmen who have not undergone chest reconstruction. Desire for birth control and fertility should also be discussed without assumptions by the provider (NPWH, 2018).
RECOMMENDATIONS
There are several additional suggestions in the literature to decrease disparity and improve access to care among LGBTQQ persons. Although there has been some increase in acceptance of sexual minority individuals, there is still much work needed to reduce the health disparities and identify risks: Increase education The topic of health disparities among the LGBTQQ population for social workers in licensure and post-licensure programs and a requirement for continuing education focused on health disparity, populations affected, risks factors, and recommendations for practice changes may assist to increase An Increase in knowledge and understanding on topics of concern for the LGBTQ population improves patient outcomes. Effective communication Using correct pronouns will increase a patient’s comfort level. Do not gossip or joke about any patient. Encourage coworkers in their communication with patients. If you are uncertain, avoid use of gender-related terms until you have confirmed this information with the patient. Apologize if you make an error and if there is a discrepancy with names or records. Ask what the name on the insurance card is or if the chart may have a different name. Confirm identity with date of birth. Increase data collection on transgender individuals As previously mentioned, there is minimal data available, lack of provider knowledge, and hesitancy to disclose this information to others. Four focus groups, with self-identified transgender individuals, explored the feasibility of asking about transgender identity in the Current Population Survey sponsored jointly by the U.S. Census Bureau and the U.S. Bureau of Labor Statistics (BLS; Holzberg et al., 2018). Feedback revealed some concerns about accuracy of responses since answers may be made by household proxy and because it would be difficult to create adequate response options to capture group diversity (Holzberg awareness, thereby decreasing disparity. Seek resources for continuing education
et al., 2018). General recommendations were to develop and test a variety of questions to test with other trans focus groups. Address one’s own bias Explicit bias is conscious; the person is aware of their feelings, which may be expressed in words or actions. Implicit bias is unconscious and can reflexively interfere with assessments, decision-making, and provider-patient relationships (Marcelin et al., 2019). Both explicit (conscious) and implicit (unconscious) bias should not be in healthcare. The former will take significant time and effort to overcome. Implicit bias must be uncovered and identified by the individual who must then desire to change their thoughts and behavior (Marcelin et al., 2019). Several versions of the Implicit Association Test (Greenwald et al., 1988; as cited in Marcelin et al., 2019)) can be accessed online (https:// implicit.harvard.edu/implicit/takeatest.html). Consider taking the Sexuality IAT, Transgender IAT, and Race IAT to assist with your self-evaluation. Use of screening tools and guidelines Guidelines and screening tools exist for general wellness in primary care practice and for specialty diagnosis in multiple settings. Guidelines are developed systematically through the examination and review of current evidence and are designed to improve patient outcomes. The process of development is deliberate and can be evaluated using AGREE II criteria, which include selecting a panel consisting of individuals experienced in the topic, those of relevant disciplines, and those with expertise in diversity (American Psychological Association [APA], 2002). The guides are to be specific for the type of profession and setting for their use along with the population type and age (APA, 2002). The guideline should also specify a time interval for review and revision. The development and testing of screening tools occur through literature reviews and clinical research. These tools are validated and reliability determined through further research. To provide consistent care and optimize outcomes for our LGBTQ clients, we need adequately developed guidelines that are evaluated and revised as information is updated.
EliteLearning.com/ Social-Work
Book Code: SWTX1524
Page 116
Powered by FlippingBook