Background : Transgender individuals face unique barriers to obtaining quality health care including lack of access to knowledgeable providers, financial barriers, discrimination, health system barriers and socioeconomic barriers. (Safer, et al 2016). The purpose of this pilot program was to provide additional physician directed support to a group of self- identified transgender and gender nonbinary employees at a large Technology company with the goal of improving their access to, experience of, and satisfaction with medical care.
Methods : In February 2018 the program was unrolled by internal email flier to all employees at a large technology company. Once voluntarily enrolled, a physician case manager was assigned and reached out by the patient’s preferred method (email or telephone) to address specific immediate concerns as well as offering an in depth intake to review their support system, perceived obstacles to fulfillment , complete medical, surgical, behavioral, family and sexual histories. Areas of highest need were identified in a collaborative fashion. Assistance was then provided falling under 3 categories namely provider navigation, advocacy, and medical direction. The physician case manager then followed up with the enrollee by telephone or email according to their preference either regularly (as often as every 3 weeks) versus monthly or bimonthly over a period of 10 months.
Results : A total of 44 employees enrolled in the program in 6 countries and 8 states. Of those 90% then responded to initial outreach. 85% identified as MtF (Male to Female) ,7.5% identified as FtM (Female to Male) , 5% identified as gender non binary and 2.5% were undecided. In terms of where the most support was requested, 47% sought and were provided assistance in finding a new primary care physician who had experience in transgender care. 32% sought and were provided assistance in finding a mental health provider with experience in transgender care. More than 50% of participants needed help with an insurance issue. 74% had specific questions related to HRT (hormone replacement therapy) and similarly 74% had mental health questions/concerns. 66% were interested in discussing issues related to GAS (gender affirmation surgery) 16% needed help in navigating a qualified GAS surgeon. On average the case manager spent 4 hours directly communicating with each participant. 10% underwent expert medical second opinion for a transgender related health question and 10% for a non-transgender related health question. Still pending are the end of the year survey data to measure to what extent the participants felt the program increased their experience and satisfaction with their care.
Conclusions : Transgender patients face unique challenges in accessing quality health care. A voluntary employer based program modeled after a medical home is one way to help improve the agency of transgender and gender non binary patients, connect them to qualified providers, and better engage them to demand good quality care.