When LGBTQ + people seek medical care, they face challenges other than questions of diagnosis or waiting times. The nuances of their sexual or gender identity mean that they are more likely to receive lower quality care: health workers could give birth to them incorrectly, misunderstand their family relationships and do not understand how hormone treatments will interact with other prescriptions.
The results could be detrimental, said Dr. Anesa Flentje, an associate professor at the UCSF School of Nursing and director of the Center for Sexual and Gender Minority Health at UC San Francisco. “Patients are very vulnerable when they go to the doctor,” she said. “If they are mistreated in that environment, it can be a really disturbing experience and can discourage them from returning and getting the health care they need.
“We know that there is a lack of LGBTQ + curriculum and training hours basically in the whole area, not just at UCSF,” said Matthew Beld, MPH, who identifies himself as non-binary. “What does it mean that students receive very minimal training on LGBTQ + health - and even on the basics of LGBTQ + identity: What is considered sexual orientation? What is gender identity? What is gender expression? And why are deputies important, especially in the examination room or in the research office? ”
We wanted to improve care at UCSF in general, to make sure staff were able to get the training they needed to make sure clinical and educational spaces were truly inclusive for LGBTQ + people.
According to upcoming research, about 30 to 42 percent of people from the sexual or gender minority (SGM) report experiencing discrimination in health facilities, Flentje said, and those experiences can lead to hesitation in receiving medical care, which can have a variety of long-term negative effects. such as higher rates of cardiovascular disease and smoking, as well as delayed screening. All this is especially relevant now, when the indecision regarding the vaccine has contributed to the current COVID-19 crisis.
Addressing this disconnect between health care providers and SGM communities inspired Flentje to develop an LGBTQ + health certificate program through the Center. The certificate program is based on the pioneering work of UCSF in LGBTQ + health care and is open to all UCSF staff, professors, students, fellows and residents. To date, the program has had one cohort of individuals and one entire clinic, with plans to enroll an additional cohort when it receives additional funding.
“The health certificate is really designed to be a way for people who want advanced training on LGBTQ + health,” she said. “We wanted to improve care at UCSF in general, to make sure staff were able to get the training they needed to make sure clinical and educational spaces were truly inclusive for LGBTQ + people.
Customizing Care
Flentje and Beld spent a year organizing discussions and focus groups “to find out what people really want to know and what their level of knowledge is,” Beld said, and developed a certificate from those discussions.
Program participants from different disciplines complete four hours of classes together and then dive deeper into focused learning. “The idea was to make a really customizable certificate, so that there can be a standard level of training plus specialization in a specific area of a person’s focus,” Flentje said.
This focus culminates in a project proposal to encourage change across the institution. For example, recognizing that LGBTQ + patients may have unpleasant experiences when taking with partners who are misguided or ignored, clinical staff could suggest a project to see how to improve that intake process, Flentier said. This adaptive approach allows for more targeted interventions at precisely those points where health care is most likely to betray LGBTQ + people.
Work against a decade of stress
The certificate program arose from Flentier’s own research on stress in minorities. “We have a pretty good body of evidence that shows that many of these mental health disparities, and even some physical health disparities, that have been identified among LGBTQ + populations are directly related to stigma and discrimination - with what I consider minority stress.” ” she said.
Her research, led by her colleague Nicholas Livingston from the National Center for PTSD, managed to find, among other things, a connection between harassment and the likelihood of subsequent substance abuse and other harmful outcomes.
In our clinical trials testing stress reduction interventions in minorities, we would see people change their behavior based on the experience they had 20 years ago, doing things like never holding hands with a partner in a particular block of flats because they were called there once and it felt very dangerous. That was 20 years ago - we have been dealing with that kind of stress for 20 years, “she says. “We know that stress can really have a strong effect on the body and affect the development of diseases and read through biological processes.
Over the last few years, it has become clear that these stresses are not only individual burdens, but also create an “unfavorable outcome” at the population level. Since vaccine indecision is a factor in hospitalizations and deaths from COVID-19, the Center hosted discussions earlier this year on how LGBTQ + people can see the COVID-19 vaccine.
“We talked about the barriers to getting the vaccine and personal experiences with friends who are LGBTQ + who simply don’t necessarily trust medical institutions,” Beld said. - You really should get it. “
Bai Area still
The first program cohort was 29 people: 13 students, 13 employees and three professors. “And they come from almost all areas at UCSF: we had representatives from the Faculty of Medicine, the Faculty of Medicine, Pharmacy and Physical Therapy,” Beld said.
While other LGBTQ +-focused programs in the United States focus on clinicians, the UCSF program integrates students, staff, and faculty and can be adapted to a variety of health environments, Beld said. “Rural clinics, teaching hospitals, research groups that are interested in including the LGBTQ + population and their studies. Our goal is to expand this. ”
“We have created a certificate program that is flexible enough to be completed by a full professor who has always been at the academy, but it can also be completed by security, a new medical student can complete it,” said Flentje. “That’s why we’ve tried to make it flexible enough so that it can be adapted to really improve everyone’s knowledge and get to know them where they are.”