Tailoring Care for LGBT Patients: Healthcare Providers' Practices in a Rural State

Monday, 29 July 2019: 8:00 AM

Mollie Aleshire, DNP, MSN, BSN, RN, APRN, FNP-BC, PPCNP-BC
School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
Amanda Fallin-Bennett, PhD, RN
University of Kentucky College of Nursing, Lexington, KY, USA

Purpose: This study describes how LGBT (lesbian, gay, bisexual, and transgender) friendly healthcare providers’ (HCPs) tailor their practices for LGBT patients.

Background: LGBT individuals face a multitude of health disparities when compared to the general population. These disparities are in part due to inequities in healthcare access, quality and outcomes. These disparities persist after adjusting for other factors, such as income, education, religion, geographical location, or race/ethnicity. LGBT individuals are less likely to have a primary HCP and report unmet healthcare needs and overall lack of satisfaction with healthcare services.

There are factors that contribute to LGBT health disparities at multiple social ecological levels (e.g. individual health behaviors; the patient/healthcare provider relationship; the healthcare system; and societal norms, including stigma and discrimination). At the individual level, sexual and gender minorities have a higher prevalence of multiple risk factors, such as smoking, alcohol and drug use, and lack of physical activity. LGBT individuals are less likely to report having a primary healthcare provider or engaging in continuity of care. Healthcare system barriers likely also contribute to these health disparities. Lesbian, gay, and bisexual individuals report lower levels of satisfaction with their healthcare, and individuals in same sex relationships report more trouble obtaining medical care, seeing specialists, and obtaining needed prescription medications. Despite recent advances in public policies (e.g., marriage equality), stigma and discrimination continue to negatively impact the overall well-being and healthcare of LGBT individuals. To address these healthcare disparities, more information is needed describe how LGBT friendly providers tailor their practices for LGBT patients.

Methods: This study employed a qualitative, descriptive research design. The sample was comprised of thirteen HCPs (nurse practitioners, physician assistants, or physicians) who self- identified as LGBT friendly. All HCPs were practicing in the U.S. state of Kentucky which is primarily a rural state. A one-hour, single, in-depth semi-structured phone interview was conducted with each participant. Results: Data analysis resulted in six overarching themes that describe how LGBT friendly HCPs tailor their care for LGBT patients: (1) treating lesbian, gay and bisexual patients the same as straight patients; (2) asking about sexual orientation; (3) using preferred pronouns; (4) creating a welcoming clinical space; (5) being nonjudgmental and inclusive due to previous potential negative interactions; and (6) training in LGBT health.

Discussion/Conclusion: Healthcare interaction components of disclosure of sexual orientation or gender identity and provider attributes (knowledge, communication, and attitudes) have been identified by LGBT people as key points in the healthcare experience that directly affect subsequent behaviors and therefore can affect health outcomes. These key components must be addressed in HCP-patient interactions and care within healthcare systems and within the larger community. “Making space for LGBTQ identities and experiences to be acknowledged and reflected in all levels of the healthcare system” (Baker & Beagan, 2014) must become a priority. LGBT patients who are “out” to their HCPs have overall better health outcomes.

HCPs must have sensitivity, knowledge, and awareness related to the health and social needs of LGBT people and be prepared and willing to engage in communication with their LGBT patients and to facilitate a trusting HCP- patient relationship. This and previous research highlight the need for HCP education on the importance of providing patient- centered care to LGBT individuals. HCPs must also have the healthcare system resources necessary to provide culturally-congruent care to LGBT individuals. Evidence-based strategies to promote culturally sensitive care for LGBT people include creating a welcoming, supportive, safe, inclusive environment; facilitating disclosure of sexual orientation and gender identity; advancing effective communication; and advocating for LGBT people in the healthcare system and community.

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