The Development of a Gender-Diversity Toolkit for Use in Primary Care

Background: Gender-diverse (GD) individuals (i.e. those identifying as transgender, nonbinary, gender-fluid, genderqueer, or two-spirit) face frequent discrimination, harassment, exclusion, and violence. Negative experiences in healthcare settings discourage them from seeking vital preventive and emergency care. They are at significant risk of depression, suicidality, and death by suicide. Despite a general willingness of primary care providers to care for GD patients, there is an educational void regarding available resources and best practices. This lack of education can lead to inadvertently insensitive care, a lack of trust from patients, and a sense of nervousness or incompetence for providers. Local Problem: Providers at the Beehive Comprehensive Clinic in Riverton, UT expressed interest in learning more about local resources and information for their GD patients. Methods: A toolkit was developed for providers that consisted of a catalog of local resources for patients and a presentation on best practices when caring for GD individuals. Pre- and post- intervention surveys assessed provider perceptions of knowledge and competence when caring for this population. Electronic medical records (EMR) were reviewed for 13-weeks after introducing the toolkit. The proportion of times the resource catalog was shared out of all GD patient visits was recorded. Providers were then surveyed about their satisfaction with the toolkit, its feasibility, and barriers to using it. Interventions: All clinic staff viewed the presentation on best practices and providers were encouraged to share the resource catalog with their GD patients. Results: Of the 22 (0.95% of all patients) GD patients seen regularly at the clinic, 72.7% (n=16) had visits during implementation, and 81.3% (n=13) of those seen were given the resource catalog. Following implementation, all 3 providers agreed that they were knowledgeable about local resources for GD patients and had a standardized method of documenting patient education to GD patients, while only 1 of 3 and 0 of 3 providers agreed prior to the intervention, respectively. All 3 providers agreed that the toolkit was easy to use, improved their competence in care for GD patients, and that they intended to continue using it in practice. Conclusions: The providers in this clinic will continue to care for a growing number of GD patients. It is difficult to grasp the true impact of the toolkit without interfacing with the patients themselves. Nevertheless, equipping providers with sustainable and feasible tools improves the quality of care they can provide and encourages more engagement with this vulnerable population.