Guidelines for the Primary Care of Lesbian, Gay, and Bisexual People: A Systematic Review

Abstract

PURPOSEWe assessed whether existing guidelines for the primary care of lesbian, gay, and bisexual (LGB) people meet appropriate standards of developmental rigor, and whether they provide consistent recommendations useful for primary care clinicians. METHODSWe performed a systematic review of such guidelines using the Cochrane Collaboration method. The countries searched were Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. For sources, we used electronic databases, guidelines databases, primary care professional organizations, government departments of public health, LGB health care textbooks, and national LGB organizations. We assessed the quality of existing guidelines using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and compared the recommendations from all fully appraised guidelines. RESULTSOur search did not identify any previous systematic reviews on primary care of LGB people. Of 2,421 documents identifi ed, we initially reviewed 30 and fully appraised 11, none of which completely satisfi ed the AGREE criteria for quality and only 2 of which were specifi cally designed for primary care. Developmental rigor was poor. Particular gaps were a lack of explicit inclusion criteria, independent reviewers, and updating procedures. Nonetheless, we did identify several consistent recommendations pertinent to primary care settings: guidance on inclusive clinical environments, standards for clinician-patient communication, sensitive documentation of sexual orientation, knowledge for cultural awareness, staff training, and addressing population health issues.CONCLUSIONS Currently available guidelines for LGB care are philosophically and practically consistent, and provide a degree of evidence-based clinical and systems support to primary care clinicians. There is a need, however, for evidencebased LGB guidelines that are more rigorously developed, disseminated, and evaluated specifi cally for the primary care setting.

Facilitating LGBT Medical, Health and Social Care Content in Higher Education Teaching

“…Despite these cultural shifts and while acknowledging these very positive developments, a systematic review of developed English speaking countries' guidelines and policies for LGBT primary care recently revealed a dearth of what McNair and Hegarty (2010) judged as evidence-based, rigorously developed and disseminated guidance for primary, secondary and tertiary care practitioners. Moreover, there is relatively scarce LGBT health literature that addresses and accounts for the different areas of LGBT healthcare in higher education for healthcare professionals and providers, and little practical guidance for the design and development of LGBT curriculum content in university courses.…”

Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices

“…17 Studies find that providers' inability to communicate effectively with patients results in poorer health care. 18 While existing guidelines encourage affirmative care for LGBTQ patients, 12 they generally fall short in describing the pragmatics of facilitating patient disclosure, a measure likely to reduce health care disparities for gender/sexual minorities, 12 and are perceived by the participants of this study to be inadequate for addressing the unique circumstances of rural ethnic minority patients and primary care practices burdened by resource and time constraints.…”

“…2 A 2010 systematic review of treatment guidelines for LGBTQ patients called for greater primary care research and interventions. 12 The few guidelines available ignored population-based attributes of LGBTQ people (eg, demographic and cultural), failed to acknowledge rural environs, and were considered most effective when accompanied by "audits, training and feedback" mechanisms that are difficult to implement in understaffed and underresourced primary care practices. 13 We conducted a pilot study to bring attention to the experiences of LGBTQ persons in rural, understudied, minority communities in receiving primary care and the degree to which such guidelines could possibly improve services in these clinical settings.…”

Diversidade de gênero e acesso ao Sistema Único de Saúde

“…Em estudos realizados a partir da literatura nacional (23) e internacional (24,25) sobre a homossexualidade feminina no campo da saúde, percebeu-se que se faz necessário adequar os serviços de saúde para o acesso dessa população; ofertando, especialmente, acolhimento, vínculo e cuidado a todas as usuárias, a fim de que as particularidades sejam repensadas a partir da necessidade de cada mulher atendida na consulta ginecológica.…”