What Pediatric Primary Care Providers Need to Support Transgender and Gender Diverse Youth in Primary Care: Perspectives on PCP-to-Specialist Telehealth Platforms: A Qualitative Study (Preprint)

Abstract

Access to gender-affirming care services for transgender and gender diverse (TGD) youth is limited, in part because it is currently provided primarily by specialists. Telehealth platforms that facilitate specialist to primary care provider (PCP) education and consultation may help improve access, however little is known about PCPs preferences regarding receiving this support.

The purpose of this study was to explore pediatric PCPs’ perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting.

PCPs who had previously requested support from the Seattle Children’s Gender Clinic were recruited to participate in a semi-structured, one-hour interviews over Zoom. Three different PCP-to-specialist telehealth modalities (tele-education, electronic consultation, telephonic consultation) were described and participants were invited to share their perspectives on 1) the benefits and drawbacks of each modality, 2) which modality would be most effective, and 3) the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using Dedoose qualitative analysis software using an inductive thematic analysis framework.

Interviews were completed with 15 pediatric PCPs. Benefits of the tele-education platform included developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, occurring at a scheduled time and increasing provider confidence. Drawbacks included requiring a significant time commitment and not allowing for real-time, patient-specific consultation. Benefits of the electronic consultation platform included convenient and efficient communication, documentation in the electronic health record (EHR), ability to bill for provider time and sufficient time to synthesize information. Drawbacks of this platform included EHR-related difficulties, text-based communication challenges, not receiving an answer in real time, forced conversations with patients about billing and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, benefits included having a dialogue with a specialist, compensation for PCP time and helping with high acuity or complex cases. Drawbacks included challenges associate with using the phone for communication, the limited expertise of responding providers, and lack of utility for non-emergent issues. Regarding the most effective platform, responses were mixed with 27% preferring the electronic consultation, 27% tele-education, 20% telephonic consultation, and the remaining 27% suggesting a hybrid of the three models. The ten factors important to the development of a successful PCP-to-specialist telehealth platform included: reliable, timely, engaging, non-judgmental, scalable, practical, adaptable, comprehensive, integrated and accessible.

We must develop a diverse suite of telehealth-based training and consultation services to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence promote more widespread access.

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