Factors Impacting Transgender Patients' Discomfort with Their Family Physicians: A Respondent-Driven Sampling Survey.
Factors Impacting Transgender Patients' Discomfort with Their Family Physicians: A Respondent-Driven Sampling Survey.
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DOI：
10.1371/journal.pone.0145046
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Thind A
中科院分区：
文献类型：
--
作者：
Bauer GR;Zong X;Scheim AI;Hammond R;Thind A
加拿大的变性人约占总人口的 0.5%，他们依赖家庭医生提供一般护理和过渡相关护理。然而，医生几乎没有接受过针对这一患者群体的培训，跨性别患者往往感到非常不舒服，可能会逃避医疗保健。这项研究调查了与加拿大安大略省的一位家庭医生讨论跨性别健康问题时患者不适的相关因素。 Trans PULSE 项目采用受访者驱动抽样方式对 433 名 16 岁及以上跨性别者进行了调查； 356 人有家庭医生。加权逻辑回归模型适合通过平均边际预测生成跨男性（n = 184）和跨女性（n = 172）跨性别者的流行风险比（PRR）。在 83.1%（95% CI = 77.4, 88.9）拥有家庭医生的跨性别安大略人中，大约一半的人表示在讨论跨性别健康问题时感到不适。 37.2% 的跨男性和 38.1% 的跨女性人士报告了至少一种跨性别特定的负面经历。在未经调整的分析中，社会人口统计学并不能预测不适，但那些计划通过药物改变性别但尚未开始的人更有可能报告不适（跨男性：PRR = 2.62（95％CI = 1.44，4.77）；跨女性：PRR = 1.85（95％CI = 1.08，3.15））。调整其他因素后，医生对跨性别问题的了解越多，不适的可能性就越小，而以前与家庭医生的跨性别特异性负面经历则增加了不适。报告三种或以上负面经历的变性女性者报告不适的可能性是变性男性者的 2.26 倍，变性男性者报告不适的可能性是变性男性者的 1.61 倍。在调整后的分析中，社会人口统计学关联因性别而异，曾婚或受过高等教育与跨性别女性的不适风险增加相关，但跨男性人群的风险降低。在这些跨性别人群中，与家庭医生讨论跨性别健康问题时感到不舒服的情况很常见，尽管拥有正规的家庭医生和“全民”健康保险，但仍对获得初级保健构成了障碍。
Representing approximately 0.5% of the population, transgender (trans) persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada. 433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs) via average marginal predictions, for transmasculine (n = 184) and transfeminine (n = 172) trans persons. Among the 83.1% (95% CI = 77.4, 88.9) of trans Ontarians who had a family physician, approximately half reported discomfort discussing trans health issues. 37.2% of transmasculine and 38.1% of transfeminine persons reported at least one trans-specific negative experience. In unadjusted analysis, sociodemographics did not predict discomfort, but those who planned to medically transition sex, but had not begun, were more likely to report discomfort (transmasculine: PRR = 2.62 (95% CI = 1.44, 4.77); transfeminine: PRR = 1.85 (95% CI = 1.08, 3.15)). Adjusted for other factors, greater perceived physician knowledge about trans issues was associated with reduced likelihood of discomfort, and previous trans-specific negative experiences with a family physician with increased discomfort. Transfeminine persons who reported three or more types of negative experiences were 2.26 times as likely, and transmasculine persons 1.61 times as likely, to report discomfort. In adjusted analyses, sociodemographic associations differed by gender, with being previously married or having higher education associated with increased risk of discomfort among transfeminine persons, but decreased risk among transmasculine persons. Within this transgender population, discomfort in discussing trans health issues with a family physician was common, presenting a barrier to accessing primary care despite having a regular family physician and “universal” health insurance.