Care of Transgender Patients: A General Practice Quality Improvement Approach

Area of Science:

• Health Services Research
• Primary Care Medicine
• Transgender Health

Background:

• Transgender and gender minority (TGM) patients experience poorer health outcomes and adverse healthcare encounters.
• Primary care settings are crucial for providing continuous, high-quality lifelong care to TGM individuals.

Purpose of the Study:

• To audit and analyze the care received by TGM patients within a specific primary care population in England.
• To identify deficiencies in care pathways, assessments, interventions, monitoring, and complication management for TGM patients.

Main Methods:

• Development of a novel data collection instrument to assess TGM patient care.
• Audit of a TGM patient sample by general practitioners against established care standards.
• Comparison of current practices with international secondary care guidelines due to lack of primary care standards.

Main Results:

• No appropriate primary care audit standard for TGM care was identified.
• Significant inconsistencies were found between UK Gender Identity Clinic (GIC) schedules and specialty guidelines.
• Up to two-thirds of TGM patients appeared to miss recommended monitoring standards, influenced by GIC and international guideline discrepancies.

Conclusions:

• There is an urgent need for an evidence-based primary care guideline with measurable standards for TGM healthcare.
• Findings indicate long waiting times, high medical complexity, and suboptimal treatment outcomes, including hormone cessation due to regret or detransition.
• The quality improvement approach should be scaled and replicated to improve TGM patient care nationwide.