Lesbian, gay, bisexual, and transgender (LGBT) individuals may experience disparities in access to care that adversely affect health outcomes. Implementation of an intervention tool increased the quality of primary care visits for LGBT patients with respect to creating inclusive environments, collecting sexual orientation and gender identity (SOGI) data, and conducting screening for sexually transmitted infections, according to a study published in Annals of Family Medicine.
The intervention, called Transforming LGBT Care, took place from March 2016 to 2017 and blended evidence-based models: the Practice Improvement Collaborative and Project Extension for Community Health Outcomes. The intervention was implemented in 10 federally qualified health centers (FQHCs), which were chosen based on their commitment and ability to implement guidance put forth by the study authors. The centers were located in both rural and urban areas throughout the United States and were not financially compensated for their participation.
Each FQHC assembled a 4 or 5-person team that included 1 quality improvement facilitator, a clinical “champion,” and 2 or 3 additional staff members. Teams also collaborated with electronic health record (EHR) vendors to improve capturing SOGI and sexual risk data. The staff received monthly coaching calls, role-specific training, and access to free resources from a digital training center. Clinicians developed scripts for answering patient questions in real time while working with LGBT patient advisory groups. Administrative leaders were encouraged to announce their support of the intervention as they trained their teams on LGBT health disparities and culturally affirming communication.
The intervention expanded from 10 clinicians at 10 sites to 431 clinicians at 79 clinical sites. FQHCs reported increases in culturally affirming practices including patient pronoun information (42.9% increase), identifying staff members who identified as an LGBTQ liaison (300% increase), and new hire training on behavioral health needs for LGBT patients (200% increase). Asking patients SOGI questions increased by 350%.
SOGI data collection increased by 276.3% for 8 of the 10 FQHCs. Prior to the intervention, 23,835 patients (13.5%) had their SOGI information documented; however, 104,583 patients (50.8%) had their SOGI data recorded after implementation of the intervention.
For LGBT patients, the intervention resulted in an 86.5% increase in syphilis screening, 109% increase in chlamydia and gonorrhea screening, and 132% increase in HIV screening.
One of the challenges for the FQHCs was capturing risk-based sexual health screening. None of the 10 FQHCs were able to record risk-based sexual histories for LGBT patients in a structured format within EHRs; the study authors were not able to analyze if training clinicians received on this objective made an impact.
“The willingness of FQHCs to actively participate in a time-intensive intervention without financial compensation suggests that this type of intervention is desirable and holds a promise for national replication in other FQHCs or other primary care organizations with a strong commitment to improving LGBT health care,” the study authors concluded.
Furness B, Goldhammer H, Montalvo W, et al. Transforming primary care for lesbian, gay, bisexual, and transgender people: a collaborative quality improvement initiative. Ann Fam Med. 2020;18(4)292-302.