Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices

Abstract

Purpose: Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities.Methods: We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps.Results: Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n ‫؍‬ 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents.Conclusions :

Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State

“…Perceived stigma in clinical settings may discourage MSM from accessing needed health care services to advance sexual health and overall well-being (Clift & Kirby, 2012;Eaton et al, 2015;Sabin, Riskind, & Nosek, 2015). Experiences may be exacerbated in socially conservative and rural areas where LGBT populations have less access to quality, LGBT-sensitive care (Kano, Silva-Bañuelos, Sturm, & Willging, 2016;Rosenkrantz, Black, Abreu, Aleshire, & Fallin-Bennett, 2016;Whitehead et al, 2016). As such, MSM are required to travel farther to find LGBT-affirming providers within Oklahoma and neighboring states who may be willing to see LGBT patients and who would also be willing to prescribe PrEP.…”

Rural Primary Care Providers’ Experiences and Knowledge Regarding LGBTQ Health in a Midwestern State

“…For rural LGBTQ patients, long‐term relationships with providers can be a mechanism for mediating documented concerns related to anticipated stigma and “outing” oneself to multiple medical providers . With its wide scope and focus on prevention, primary care is uniquely poised to address concerns of vulnerable and minority groups, such as rural LGBTQ individuals …”

“…34 With its wide scope and focus on prevention, primary care is uniquely poised to address concerns of vulnerable and minority groups, such as rural LGBTQ individuals. 35 Despite the advantageous position of primary care providers to address the health concerns of rural LGBTQ individuals, little is known about their actual knowledge or experiences with this subpopulation. 21 A recent review of literature concerning the health of rural LGBTQ individuals 21 found only 3 studies assessing the educational preparedness of rural health care providers.…”

Are We Learning More about Patient-centered Medical Homes (PCMHs), or Learning More about Primary Care?

“…In addition, in this issue Kano et al 16 single out the lesbian/gay/bisexual/trans/queer population and demonstrates the impact of moving from a one-size-fits-all model of primary care to a population-driven design meant to be accessed by specific segments of the community. Thinking through the needs of specific populations not only achieves better quality care but engenders a patient's perception of better service.…”