Transforming Primary Care for Lesbian, Gay, Bisexual, and Transgender People: A Collaborative Quality Improvement Initiative

Abstract

PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) people experience multiple disparities in access to care and health outcomes. We developed a quality improvement initiative, Transforming Primary Care for LGBT People, to enhance the capacity of federally qualified health centers (FQHCs) to provide culturally affirming care for this population.METHODS The 1-year intervention blended the models of Practice Improvement Collaboratives and Project ECHO (Extension for Community Health Outcomes) to facilitate learning and translate knowledge into action. FQHC teams received coaching in creating LGBT-inclusive environments, collecting sexual orientation and gender identity (SOGI) data, taking risk-based sexual histories, and screening LGBT people for syphilis, chlamydia and gonorrhea, and HIV. We used a preintervention-postintervention evaluation design. RESULTSWe selected 10 FQHCs serving 441,387 patients in 123 clinical sites in 9 states. The intervention spread from 10 clinicians in 10 clinical sites to 431 clinicians in 79 clinical sites. FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9% increase) and identifying LGBT patient liaisons (300.0% increase). Postintervention, among 9 FQHCs reporting SOGI data from electronic health records, SOGI documentation increased from 13.5% to 50.8% of patients (276.3% increase). Among 8 FQHCs reporting number of LGBT patients, screening of LGBT patients increased from 22.3% (95% CI, 4.9%-40.0%) to 34.6% (95% CI, 19.4%-48.6%) for syphilis (86.5% increase); from 25.3% (95% CI, 7.6%-43.1%) to 44.1% (95% CI, 30.2%-58.1%) for chlamydia and gonorrhea (109.0% increase); and from 14.8% (95% CI, 3.2%-26.5%) to 30.5% (95% CI, 26.7%-34.3%) for HIV (132.4% increase).CONCLUSIONS FQHCs participating in this initiative reported improved capacity to provide culturally affirming care and targeted screening for LGBT patients.

Rectal specimen self-collection for chlamydia and gonorrhea screening: a cross-sectional feasibility study at a community health center

“…Recruitment was initiated on March 1, 2018, following implementation of a Health Resources and Services Administration (HRSA)-mandated process to routinely collect and report SOGI data at FQHCs [ 22 ] and CHCI’s participation in a quality improvement initiative aimed at further increasing ability to use SOGI data to offer routine risk-based STI screening [ 23 ]. Recruitment was opportunistic and ended on March 1, 2020, due to restrictions on in-person visits imposed by the COVID-19 pandemic.…”

“…The Centers for Disease Control and Prevention’s Recommendations for Providing Quality Sexually Transmitted Disease Clinical Services (2020) note that STIs are increasingly treated in primary care [ 29 ] and recommend that basic STI services should be made available in these settings. However, primary care community health centers, including FQHCs, have only recently (January 2018) been required to collect SOGI data [ 30 ], and often do not conduct risk-based sexual health screening [ 23 ]. Though our study demonstrates the feasibility of offering rectal STI screening during a primary care visit, further studies are needed to determine how primary care clinics can increase their capacity to offer comprehensive STI clinical services including sexual risk assessment, risk reduction counseling, and partner-services, which are commonly available in specialty STI clinics [ 31 ].…”

Rectal Specimen Self-Collection for Chlamydia and Gonorrhea Screening: A Cross-Sectional Pilot Feasibility Study at a Community Health Center

“…However, primary care community health centers, including FQHCs, have only recently (January 2018) been required to collect SOGI data [23], and often do not conduct risk-based sexual health screening. [24] Though our pilot study demonstrates the feasibility of offering rectal STI screening during a primary care visit, further studies are needed to determine how primary care clinics can increase their capacity to offer comprehensive STI clinical services including sexual risk assessment, risk reduction counseling, and partner-services, which are commonly available in specialty STI clinics. [25] Nevertheless, continued emphasis on SOGI data collection in primary care health centers is critical.…”

Organizational Strategies and Inclusive Language to Build Culturally Responsive Health Care Environments for Lesbian, Gay, Bisexual, Transgender, and Queer People

“…Experience and research tells us that opposition to LGBTQ inclusion eff orts can be prevented or mitigated by educating patients through letters or pamphlets about the benefi ts of these eff orts. 26,33 Translations into languages other than English may also be needed and should be checked by community members as well.…”