Survey Finds One-Third of Primary Care Practices Provide Clinician Training on LGBTQ+-Affirming Care
Practices with high proportion of Medicaid payers, in Federally Qualified Health Centers, and in states with LGBTQ+-supportive policies were most likely to provide training
A new study based on a national survey fielded in 2022-2023 found that 34% of primary care practices provided LGBTQ+-specific training for clinicians, while 39% provided such training for staff.
The study also found that the majority of primary care practices reported collecting patient information on gender identity (77%), sexual orientation (76%), and patients’ pronoun data (66%).
The study, published online March 10 in JAMA Network Open, was led by Ellesse-Roselee Akré, PhD, MA, an assistant professor in the Johns Hopkins Bloomberg School of Public Health’s Department of Health Policy and Management, with a team from the Dartmouth Institute for Health Policy and Clinical Policy at the Geisel School of Medicine and the Eli Coleman Institute for Sexual and Gender Health at the University of Minnesota.
“High-quality primary health care has been shown to produce better population health outcomes and reduce health disparities broadly,” says Akré. “LGBTQ+ patients are known to be at higher risk for certain health conditions due to structural and social determinants of health, and this study documents not only the varying levels of care quality they are experiencing, but specific practice-level challenges and potential policy solutions to address them.”
For their study, the researchers analyzed responses from 1,245 primary care practices in the National Survey of Healthcare Organizations and Systems (NSHOS II). Conducted from June 2022 to February 2023, the survey included questions to capture the structure and care capabilities of health care systems and providers across the country, as well as their inclusivity, accessibility, and efficiency efforts.
The researchers focused on primary care practices’ involvement in sexual orientation and gender identity (SOGI)-affirming activities. These activities include collecting and using SOGI data, offering LGBTQ+-focused training, and providing referrals and services.
The researchers found that Federally Qualified Health Centers (FQHCs)—centers that provide care for underserved communities—and practices with a high Medicaid payer mix were more likely to engage in LGBTQ+ affirming activities compared to non-FQHCs or practices with a lower Medicaid payer mix.
Practices in states with laws and policies protecting LGBTQ+ communities were more likely to engage in affirming activities than those in states without such protections, reflecting the influence of supportive state policies.
“Federally Qualified Health Centers demonstrate what’s possible when resources and accountability are in place,” Akré says. “Their higher engagement rates are a testament to the impact of targeted mandates, such as the Health Resources and Services Administration’s data reporting requirements.”
The researchers’ analysis found that rural areas and states in the South Census region showed the lowest likelihood of engaging in affirming activities as compared to practices located in urban and the Midwest Census region, reflecting a combination of resource limitations and sociopolitical barriers. The authors note that rural practices often struggle with resource constraints, hindering their ability to provide services in general. Addressing these limitations calls for targeted investments and enabling policies by state and federal policymakers that prioritize health equity for populations in underserved regions.
The authors call for broad policy changes to bridge gaps in LGBTQ+-affirming care, including requiring LGBTQ+ competency training for health care professionals and integrating training into medical and nursing education. The authors note that uniform SOGI data collection across all practices is essential for identifying and addressing disparities and enhancing protective laws and inclusive health care policies, which can improve health outcomes nationwide.
This study was supported by the Robert Wood Johnson Foundation (78479 and 81412).
“A National Survey of Sexual Orientation and Gender Identity (SOGI) Affirming Activities Provided in Primary Care in the United States” was written by Ellesse-Roselee Akré, Ching-Wen Wendy Yang, Greta Bauer, Matthew B. Mackwood, James O’Malley, Elliott Fisher, and Karen Schifferdecker.
For media inquiries please contact Kate Sam at ksam2@jh.edu.
