A Project Extension For Community Health Care Outcomes Improves Provider Confidence and Behaviors in Gender-Affirming...

We aimed to evaluate how participation in a Project ECHO (extension for community health care outcomes) focused on caring for gender diverse youth supported the creation of gender-affirming clinic environments and changed pediatric provider confidence and behaviors related to gender-affirming care.

We developed a Project ECHO entitled "Caring for Gender Diverse Youth," with 2 series of 6 monthly sessions each, focused on facilitating gender-affirming care in the primary care setting. All participants were asked to complete an anonymous survey at 3 time points during each series: a pre-, midpoint, and postsurvey. Surveys included items exploring providers' demographic characteristics, and assessed provider confidence and behaviors in multiple areas of gender-affirming care.

Fifty-eight participants completed surveys for Series 1 and 61 for Series 2 (39-41% physicians). Significant improvements were seen in the majority of the confidence items, such as confidence in ability to initiate conversations about gender identity during routine visits (mean score increased from 3.71 to 4.08 on a scale of 1-5), support a gender diverse patient in talking with their parent or caregiver about their gender identity (increased from 3.86 to 4.22), and provide information about local resources (increased from 3.44 to 3.97). However, there was limited change in the development of gender-affirming clinical environments and in provider behaviors.

Our Project ECHO led to significant improvement in provider confidence in many areas of gender-affirming care; however, additional resources are needed to improve care at a system level and to increase access to care for youth seeking gender-affirming medical care.