No abstract

Context:LGBTQ+ persons experiences high rates of health disparities including low access, and higher rates of medical discrimination in comparison to their non-LGBTQ+ peers. Student-run free clinics are an important medical service for patients who may not otherwise be able to receive care and are a site of medical education. To date, there has been limited exploration of providing LGBTQ+ care in the studentrun free clinic setting. Objective: To determine patient, student, and clinician perceptions of receiving and providing LGBTQ+ care in a student-run free clinic setting. Study Design: A qualitative study including participant observation of public spaces within the clinic and semi-structured interviews with patients, students, and physicians. Ethical approval was given by the University of Florida Institutional Review Board. Recruitment used theoretical and purposive sampling approaches. Analysis utilized an inductive approach to build a conceptual framework describing participants' experiences. Setting:English speaking participants, 18 years or older were recruited at the student-run free clinic "LGBTQ night". Population Studied: Patients, medical students, and physicians associated with the student-run free clinic "LGBTQ Night". Instrument: Semi-structured interviews; participant-observation. Outcome measures: Themes in factors affecting satisfaction with, and provision of LGBTQ+ affirming healthcare in the student-run free clinic setting. Results: We observed approximately 60 hours of clinical operations and interviewed 18 patients, 6 physicians, and 6 students. Overall patients were satisfied with the quality of care, and sensitivity to LGBTQ+ populations exhibited by students and physicians in the clinic. Trans patients made up a large portion of our patient sample. Patients described lack of provider understanding of non-binary identities, and lack of access to LGBTQ+ affirming care. Physicians described varying comfort in managing HRT, challenges and opportunities for medical education, and rewards of working with LGBTQ+ patients. Medical students described overwhelmingly positive experiences with patients and the clinic. Interestingly discussions of the care of lesbian women and asexual individuals was notably absent from all interviews. Conclusions: The student-run free clinic can be an appropriate and successful site for LGBTQ+ affirming care. Awareness of issues concerning lesbian and asexual individuals may warrant further investigation.