Inclusive care is 'essential' for the LGBTQ+ community

Having access to an affirming provider is critical for reducing health disparities in the LGBTQ+ population, according to researchers.

“Experiences of discrimination and bias in healthcare contribute to health disparities for lesbian, gay, bisexual, transgender and queer populations. To avoid discrimination, many go to great lengths to find healthcare providers who they trust and who are knowledgeable about their health needs,” Tara McKay, PhD, of Vanderbilt University’s department of medicine, health and society, department of health policy and LGBTQ+ policy lab, and colleagues wrote.

To better understand if health outcomes for members of the LGBTQ+ community are affected by access to an affirming provider, McKay and colleagues conducted a cross-sectional study and published their findings in the American Journal of Preventive Medicine.

The researchers evaluated survey data from Wave 1 of the Vanderbilt University Social Networks, Aging and Policy Study. The panel study, which examined the health of LGBTQ+ adults aged 50 to 76 years, included 1,120 participants. The researchers used Poisson regression models to evaluate survey data collected between April 2020 and September 2021.

They found that “overall, access to an affirming provider is associated with greater uptake of preventive health screenings and improved management of mental health conditions.”

In all, 17.5% of survey respondents indicated that they did not want or need an affirming provider, 13.1% could not find one and 63% reported having an affirming provider.

“Participants with an affirming provider are more likely to have ever and recently received several types of preventive care than participants reporting a usual source of care that is not affirming, including past-year provider visit, influenza vaccination, colorectal cancer screening and HIV test,” the researchers wrote. “Access to an affirming provider is also associated with better management of mental health conditions.”

Additionally, those with affirming providers “were more likely to have ever and recently received several types of preventive care than respondents receiving standard care.”

Respondents with an affirming provider were:

• 7.8% (95% CI=2.2-13.7) more likely to have had an influenza vaccination in the last 3 years;
• 7% (95% CI=0.1-14.3) more likely to have ever had a colorectal cancer screening;
• 6% (95% CI=1.2-11.1) more likely to have ever had an influenza vaccination; and
• 3.8% (95% CI=1.1-6.7) more likely to have seen a doctor in the past year.

Additionally, when it came to mental health, respondents were 10.8% (95% CI= 1.4-24.4) more likely to “report their condition under control when they had an affirming provider than when they were receiving standard care.”

Notably, McKay and colleagues found “significant differences in the distribution of access to an LGBTQ+-affirming care provider across several demographic characteristics.” Those who reported having an affirming provider were more likely to:

• be cisgender men (P < 0.05) or transgender women (P < 0.05) than cisgender women;
• to be gay than bisexual (P = 0.001);
• to be living with HIV (P < 0.001);
• to have completed a degree than to have less than a college degree (P = 0.05); and
• to be living in North Carolina than in Alabama (P = 0.05).

The researchers concluded that not only is inclusive care helpful in reducing health disparities in the LGBTQ+ population, but is in fact “essential.”

“Health systems can reduce disparities by expanding continuing education opportunities; adopting nondiscrimination policies for patients and employees; and ensuring that necessary care is covered by health insurance.”

The researchers wrote that “health systems should prioritize LGBTQ+-inclusive best practices to achieve health equity for LGBTQ+ populations.”

To “promote higher uptake of preventive care and better mental health management among individuals with an affirming provider,” providers can use visual cues, like a rainbow pin, or talking with their patients about possible health risks, they wrote.

“In general, physicians and nurses have few or no reservations about providing care to LGBTQ+ populations; however, they often feel unprepared to support LGBTQ+ patients across a range of health needs (emergency medicine, cancer care, dementia care, palliative care, and others) given limited engagement with LGBTQ+ health in medical curricula, even when they also identify as LGBTQ+.”

These changes, McKay and colleagues wrote, could be a first step in the effort “toward improving LGBTQ+ engagement with preventive services, reducing healthcare fragmentation, and ensuring the opportunity of access to all members of the LGBTQ+ community.”

“Expanding access to LGBTQ+-affirming providers across the health system may help narrow the disparities in morbidity for LGBTQ+ older adults and intervene in the poorer health trajectories of LGBTQ+ people in many Southern states,” they wrote. “To increase access to LGBTQ+-affirming providers, medical education and healthcare systems must expand formal and continuing education opportunities around LGBTQ+ medicine and adopt best practices for LGBTQ+-affirming care.”