Aug 04 2022
Patient-Centered Care

How Does Telehealth Expand Healthcare Access for LGBTQ Patients?

Virtual care provides a safe and affirming method of care delivery for LGBTQ patients, no matter where they are located.

For LGBTQ patients, telehealth provides more than just convenience. It increases access to care for those who may be unable to access safe and affirming care locally. Many LGBTQ patients have faced discrimination or stigma in their healthcare experiences. Virtual care solutions can offer a lifeline to patients who may otherwise be unable to access the healthcare services they need safely and comfortably.

Dr. Jerrica Kirkley is co-founder and chief medical officer of Plume, a virtual care service that offers gender-affirming hormone therapy. She says the company was created in response to the experiences of her patients as well as her own experiences as a trans person navigating the healthcare system.

“What we saw were a lot of barriers and challenges that came up in a physical environment, such as discrimination. Upward of a third of trans people are actively discriminated against in healthcare settings. However, discrimination and bias exist outside of the actual healthcare space as well,” she explains. “Even just getting to the clinic can be challenging. Just walking outside our door can be intimidating, daunting and, unfortunately, dangerous at times. So, there’s a whole chain of events before you even see the clinician.”

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In addition to those barriers, gender affirming care is not a standard part of the training most healthcare professionals receive, leaving many physicians and practitioners unprepared to provide treatments such as hormone therapy or understand the unique needs and lived experiences of trans patients. This is especially true outside of metro areas, making it difficult for LGBTQ patients in rural areas and in the suburbs to find clinicians trained to treat the community’s unique needs.

“If you go through that whole physical process of getting to the clinic, often the clinicians aren’t able to provide the care you need, or they may do it in a way that can be very nonaffirming and upsetting,” says Kirkley.

Virtual care can remove these barriers and increase access to care for LGBTQ patients, wherever they are, without creating another potentially negative healthcare experience. However, it’s important that healthcare organizations looking to provide telehealth services to the LGBTQ community understand best practices to ensure a positive experience.

MORE ON TELEHEALTH: Learn tips on keeping equity at the forefront in telehealth.

Telehealth Expands Care Access for LGBTQ Patients

Virtual care companies such as Plume can source providers from all over the country. If a physician anywhere in the U.S. has the appropriate medical license for the state where the patient is, and follows the relevant laws, that physician can provide care no matter where they live.

“We’ve built a system that is virtually accessible. The core premise is to be affirming, provide joy in the healthcare experience, meet patients where they are and provide high-quality healthcare by bringing together a group of clinicians that otherwise would be unable to come together due to geographical constraints,” says Kirkley.

Plume is 100 percent virtual. Patients find the service through advertisements, community webinars, social media, blogs or word of mouth. The website takes patients to a HIPAA-compliant patient communication platform that allows them to communicate with their care team at any time via messages, phone calls or video calls. Medication information, consent forms and other resources are also available through the platform.

Dr. Jerrica Kirkley
Even if you have the best insurance in the world, if you don’t have a provider located near you that you can access, you can’t use that insurance. We always say that coverage doesn’t equal access and it doesn’t equal care.”

Dr. Jerrica Kirkley Co-Founder and Chief Medical Officer, Plume

The leadership behind Plume knew that a virtual access point would be critical for providing safe and affirming care to trans patients. Kirkley says telehealth isn’t just a convenient or nice-to-have option, but a preferred choice for many trans patients.

However, she points out that insurance can still be a barrier to care for many, as some states refuse to cover trans-related care through Medicare and Medicaid. Many private insurance companies provide coverage, but Kirkley says there’s room for improvement.

“Even if you have the best insurance in the world, if you don’t have a provider located near you that you can access, you can’t use that insurance,” she says. “We always say that coverage doesn’t equal access and it doesn’t equal care. You really have to align those three.”

Best Practices for Providing Virtual Care to LGBTQ Patients

Healthcare organizations or providers looking to expand, add or improve care options for LGBTQ patients should first talk to members of the community to understand their healthcare experiences and needs, according to Kirkley.

“It’s also important to understand, of course, that no one person is representative of all people’s experiences. It’s good to get as many voices around the table as possible,” she says.

One aspect of affirming care that shouldn’t be overlooked is the language used within patient-facing forms and technology. Kirkley emphasizes the importance of using a patient’s gender identity and pronouns throughout a platform and in all forms, as well as the patient’s chosen name if different from their legal or given name.

“Ensuring that the technology you’re building has that capability is super important. If we’re giving patients forms or they’re logging in to something regularly and they have to use what we call their dead name, or a name that is not their chosen name, or see a gender marker that doesn’t reflect who they are, that’s incredibly nonaffirming,” she says, adding that the experience can lead to negative mental health outcomes. “Many people who aren’t trans don’t think about that, but it’s important to get that right.”

WATCH: Discover how to get the most out of virtual care technology.

The U.S. Department of Health and Human Services also suggests that healthcare organizations encourage clinicians and staff to take LGBTQ health education training as part of their telehealth workflow. To improve the telehealth experience for LGBTQ patients, the organization suggests that providers ensure the patient has privacy and feels safe to speak openly at the start of a telehealth appointment; assure the patient that the information discussed during the appointment is confidential; confirm the patient’s pronouns and chosen name; and help the patient find local physicians that can provide affirming care if an in-person visit is needed.

In addition, Kirkley emphasizes the importance of moving beyond the typical disease-based model of care, which focuses on using standard treatments across all patient populations, “often without acknowledging the people who are attached to those medical conditions and what else might be going on in their lives.”

Instead, healthcare providers should consider how they can provide care to a specific community. Doing so will validate those patients’ experiences and can lead to better health outcomes, says Kirkley.

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