Use of Telemedicine to overcome barriers to care among transwomen of color

描述(由申请人提供)：变性人群体是一个医疗服务不足和研究不足的群体，有无数的护理障碍。歧视、药物滥用、暴力、污名、艾滋病毒/性传播感染危险行为以及社会隔离对为有色人种变性人妇女(TW)提供初级和专科服务提出了挑战，因此迫切需要新的护理模式。这项申请将提供远程医疗应用的试点数据，以提供虚拟医疗之家，作为一种参与和保持护理中TW颜色的手段。这项研究将评估一种新的针对TW的远程医疗方法的可接受性和可行性，以减少护理障碍。通过远程提供对文化敏感的TW护理的实时访问，我们可以克服经常遇到的结构性障碍。这项研究提供了将高效的远程医疗方法转化为 这种方法尚未在其上进行测试的人群。如果被证明是可行的、可接受的，并与改善参与和保留护理的意图相关，通过这项先导性研究获得的信息将作为未来R34或R01研究的基础。这项研究的目的是评估远程医疗作为虚拟医疗之家的可接受性和可行性，以克服在不受照顾的有色人种人群中使用医疗服务的障碍。研究分两个阶段进行：1)在第一阶段，我们会与TW的提供者进行主要线人访谈，并与TW本身进行主要线人和焦点小组的访谈，以评估远程医疗方法的可接受性。2)在第二阶段，我们将采用同辈转介的方式，招募25名失护妇女，他们将有3个月的对比期，然后是3个月的远程医疗/虚拟医疗之家试点研究期。这一目标将评估 方法及其与主要结果的关联，包括寻求护理的意向和医疗保健利用行为。如果成功，远程医疗可能会为 医疗服务不足和亟需医疗服务的弱势人群。

DESCRIPTION (provided by applicant): The transgender population is a medically underserved and understudied population with myriad barriers to care. Discrimination, substance abuse, violence, stigma, HIV/STI risk behaviors, and social isolation challenge delivery of primary and specialty services for transgender women of color (transwomen, TW), and thus new models of care are urgently needed. This application will provide pilot data on the application of telemedicine to provide a virtual medical home as a means to engage and retain TW of color in care. This study will assess the acceptability and feasibility of a novel telemedicine approach specific to TW to reduce barriers to care. By providing real-time access to culturally-sensitive care for TW remotely, we can overcome frequently encountered structural barriers. This study offers the opportunity to translate highly effective telemedicine methods to a population on whom this approach has not yet been tested. If shown to be feasible, acceptable, and associated with improvements in intentions to engage and retain in care, information gained through this pilot study will serve as the foundation for a future R34 or R01 study. The purpose of this study is to assess acceptability and feasibility of telemedicine as a virtual medical home to overcome barriers to utilization of healthcare services among out-of-care TW of color. The study has two phases: 1) In Phase I, we will conduct key informant interviews with providers of TW, and key informant interviews and focus groups with TW themselves to evaluate the acceptability of the telemedicine approach. 2) In Phase II, we will use peer-referral to will recrut a sample of 25 out-of-care TW who will have a 3 month comparison period followed by a 3 month telemedicine/virtual medical home pilot study period. This aim will assess the feasibility of the approach and its association with primary outcomes including intention to seek care and healthcare utilization behavior. If successful, telemedicine may offer an innovative strategy for a medically underserved and vulnerable population in urgent need of healthcare services.