A formative evaluation to inform integration of psychiatric care with other gender-affirming care.

Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9918300889006676 Publication Model: Electronic Cited Medium: Internet ISSN: 2731-4553 (Electronic) Linking ISSN: 27314553 NLM ISO Abbreviation: BMC Prim Care Subsets: MEDLINE

Original Publication: [London] : BioMed Central Ltd., [2022]-

Delivery of Health Care, Integrated*/organization & administration ; Transgender Persons*/psychology ; Mental Health Services*/organization & administration ; Primary Health Care*/organization & administration; Humans ; Female ; Male ; Adult ; Qualitative Research ; Mental Disorders/therapy ; Middle Aged ; Health Services Accessibility/organization & administration ; Gender-Affirming Care

Background: Transgender, non-binary, and/or gender expansive (TNG) individuals experience disproportionately high rates of mental illness and unique barriers to accessing psychiatric care. Integrating TNG-specific psychiatric care with other physical health services may improve engagement, but little published literature describes patient and clinician perspectives on such models of care. Here we present a formative evaluation aiming to inform future projects integrating psychiatric care with physical health care for TNG individuals.
Methods: In this qualitative pre-implementation study, semi-structured interview guides were developed informed by the Consolidated Framework for Implementation Research to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. We elicited TNG patient (n = 11) and gender-affirming care clinician (n = 10) needs and preferences regarding integrating psychiatric care with other gender-affirming clinical services. We conducted a rapid analysis procedure, yielding a descriptive analysis for each participant group, identifying challenges of and opportunities in offering integrated gender-affirming psychiatric care.
Results: Participants unanimously preferred integrating psychiatry within primary care instead of siloed service models. All participants preferred that patients have access to direct psychiatry appointments (rather than psychiatrist consultation with care team only) and all gender-affirming care clinicians wanted increased access to psychiatric consultations. The need for flexible, tailored care was emphasized. Facilitators identified included taking insurance, telehealth, clinician TNG-competence, and protecting time for clinicians to collaborate and obtain consultation.
Conclusions: This health equity pre-implementation project engaged TNG patients and gender-affirming care clinicians to inform future research exploring integration of mental health care with primary care for the TNG community and suggests utility of such a model of care.
(© 2024. The Author(s).)

Psychosomatics. 2020 Nov - Dec;61(6):632-644. (PMID: 32381258)
JAMA. 2021 Aug 17;326(7):621-627. (PMID: 34402850)
Health Aff (Millwood). 2022 Nov;41(11):1645-1651. (PMID: 36343311)
Psychiatr Serv. 2024 Feb 1;75(2):178-181. (PMID: 37554006)
Implement Sci. 2022 Oct 29;17(1):75. (PMID: 36309746)
Pediatrics. 2021 Sep;148(3):. (PMID: 34462339)
J Gen Intern Med. 2006 Feb;21 Suppl 2:S1-8. (PMID: 16637954)
Andrology. 2021 Nov;9(6):1808-1816. (PMID: 32777129)
J Gen Intern Med. 2017 Apr;32(4):404-410. (PMID: 28243873)
Obstet Gynecol. 2019 Nov;134(5):959-963. (PMID: 31599839)
J Am Board Fam Med. 2016 Jan-Feb;29(1):156-60. (PMID: 26769889)
J Nurs Manag. 2021 Jan;29(1):95-103. (PMID: 33090583)
Int J Equity Health. 2022 Jul 31;21(1):104. (PMID: 35907962)
Int J Eat Disord. 2023 Dec;56(12):2210-2222. (PMID: 37638738)
Fam Syst Health. 2017 Sep;35(3):308-319. (PMID: 28805403)
Clin Obstet Gynecol. 2018 Dec;61(4):646-662. (PMID: 30303816)
BMC Health Serv Res. 2006 Jul 16;6:88. (PMID: 16842629)
N Engl J Med. 2010 Nov 11;363(20):1928-37. (PMID: 21067384)
Am J Med. 2021 Feb;134(2):158-160. (PMID: 33228952)
J Health Polit Policy Law. 2016 Aug;41(4):559-83. (PMID: 27127264)
Implement Sci. 2009 Aug 07;4:50. (PMID: 19664226)
JAMA Surg. 2021 Jul 1;156(7):611-618. (PMID: 33909023)
Prim Care. 2021 Jun;48(2):243-257. (PMID: 33985702)
Implement Sci. 2019 Feb 1;14(1):11. (PMID: 30709368)
J Telemed Telecare. 2021 Aug;27(7):397-408. (PMID: 31645171)
Focus (Am Psychiatr Publ). 2020 Jul;18(3):268-276. (PMID: 33162863)
Curr Opin Endocrinol Diabetes Obes. 2016 Apr;23(2):168-71. (PMID: 26910276)
Implement Sci. 2021 Jul 2;16(1):67. (PMID: 34215286)
J Am Board Fam Med. 2021 Feb;34(Suppl):S29-S32. (PMID: 33622814)
Psychiatry Res. 2020 Jan;283:112532. (PMID: 31477261)
Implement Sci. 2022 Jan 22;17(1):7. (PMID: 35065675)
J Adolesc Health. 2022 Apr;70(4):643-649. (PMID: 34920935)
JAMA Pediatr. 2015 Oct;169(10):929-37. (PMID: 26259143)
J Am Geriatr Soc. 2019 Aug;67(8):1565-1570. (PMID: 31140592)
Cochrane Database Syst Rev. 2012 Oct 17;10:CD006525. (PMID: 23076925)
LGBT Health. 2024 Feb-Mar;11(2):131-142. (PMID: 38052073)

Keywords: Formative evaluation; Gender-affirming; Integrated care; Mental health; Non-binary; Primary care; Psychiatry; Transgender

Date Created: 20240704 Date Completed: 20240704 Latest Revision: 20240707

20240707

PMC11225323

10.1186/s12875-024-02472-8

38965459