PDF(Pubmed)
Abstract：
UNASSIGNED: Family physicians are increasingly more likely to encounter transgender and gender-diverse (TGD) patients requesting gender-affirming care. Given the significant health inequities faced by the TGD community, this study aimed to assess changes in military-affiliated clinicians\' perspectives toward gender-affirming care over time.
UNASSIGNED: Using a serial cross-sectional survey design of physicians at the 2016 and 2023 Uniformed Services Academy of Family Physicians conferences, we studied participants\' perception of, comfort with, and education on gender-affirming care using Fisher\'s Exact tests and logistic regression.
UNASSIGNED: Response rates were 68% (n = 180) and 69% (n = 386) in 2016 and 2023, respectively. Compared to 2016, clinicians in 2023 were significantly more likely to report receiving relevant education during training, providing care to >1 patient with gender dysphoria, and being able to provide nonjudgmental care. In 2023, 26% reported an unwillingness to prescribe gender-affirming hormones (GAH) to adults due to ethical concerns. In univariable analysis, female-identifying participants were more likely to report willingness to prescribe GAH (OR = 2.6, 95%CI = 1.7-4.1) than male-identifying participants. Willingness to prescribe was also associated with ≥4 h of education (OR = 2.2, 95%CI = 1.1-4.2) compared to those with fewer than 4 h, and those who reported the ability to provide nonjudgmental care compared to those who were neutral (OR = 0.09, 95%CI = 0.04-0.2) or disagreed (OR = 0.11, 95%CI = 0.03-0.39). Female-identifying clinicians were more likely to agree additional training would benefit their practice (OR = 5.3, 95%CI = 3.3-8.5).
UNASSIGNED: Although military-affiliated family physicians endorsed more experience with and willingness to provide nonjudgmental gender-affirming care in 2023 than 2016, profound gaps in patient experience may remain based on the assigned clinician. Additional training opportunities should be available, and clinicians unable to provide gender-affirming care should ensure timely referrals. Future research should explore trends across clinical specialties.
UNASSIGNED: Using a serial cross-sectional survey design of physicians at the 2016 and 2023 Uniformed Services Academy of Family Physicians conferences, we studied participants\' perception of, comfort with, and education on gender-affirming care using Fisher\'s Exact tests and logistic regression.
UNASSIGNED: Response rates were 68% (n = 180) and 69% (n = 386) in 2016 and 2023, respectively. Compared to 2016, clinicians in 2023 were significantly more likely to report receiving relevant education during training, providing care to >1 patient with gender dysphoria, and being able to provide nonjudgmental care. In 2023, 26% reported an unwillingness to prescribe gender-affirming hormones (GAH) to adults due to ethical concerns. In univariable analysis, female-identifying participants were more likely to report willingness to prescribe GAH (OR = 2.6, 95%CI = 1.7-4.1) than male-identifying participants. Willingness to prescribe was also associated with ≥4 h of education (OR = 2.2, 95%CI = 1.1-4.2) compared to those with fewer than 4 h, and those who reported the ability to provide nonjudgmental care compared to those who were neutral (OR = 0.09, 95%CI = 0.04-0.2) or disagreed (OR = 0.11, 95%CI = 0.03-0.39). Female-identifying clinicians were more likely to agree additional training would benefit their practice (OR = 5.3, 95%CI = 3.3-8.5).
UNASSIGNED: Although military-affiliated family physicians endorsed more experience with and willingness to provide nonjudgmental gender-affirming care in 2023 than 2016, profound gaps in patient experience may remain based on the assigned clinician. Additional training opportunities should be available, and clinicians unable to provide gender-affirming care should ensure timely referrals. Future research should explore trends across clinical specialties.
摘要：
家庭医生越来越有可能遇到要求性别确认护理的变性和性别多样化（TGD）患者。鉴于TGD社区面临的重大健康不平等，这项研究旨在评估军事附属临床医生对性别确认护理的观点随时间的变化.
■在2016年和2023年家庭医生统一服务学院会议上使用医师的连续横断面调查设计，我们研究了参与者的感知，安慰,使用Fisher精确检验和逻辑回归进行性别确认护理教育。
■反应率在2016年和2023年分别为68％（n=180）和69％（n=386）。与2016年相比，2023年的临床医生报告在培训期间接受相关教育的可能性显著增加。为>1名性别烦躁不安的患者提供护理，能够提供非判断性护理。2023年，26%的人报告说，由于道德问题，他们不愿意给成年人开性别确认激素(GAH)。在单变量分析中，与男性参与者相比,女性参与者更有可能报告愿意开GAH(OR=2.6,95CI=1.7~4.1).与少于4小时的人相比，处方意愿也与≥4小时的教育有关（OR=2.2，95CI=1.1-4.2），与中立者(OR=0.09,95CI=0.04-0.2)或不同意者(OR=0.11,95CI=0.03-0.39)相比,报告有能力提供非判断性护理的人.女性识别临床医生更有可能同意额外的培训将有利于他们的实践（OR=5.3，95CI=3.3-8.5）。
■尽管在2023年与2016年相比，军事附属家庭医生认可了更多的经验并愿意提供非判断性性别确认护理，但根据指定的临床医生，患者经验可能仍然存在巨大差距。应该有更多的培训机会，无法提供性别确认护理的临床医生应确保及时转诊。未来的研究应该探索临床专业的趋势。
■在2016年和2023年家庭医生统一服务学院会议上使用医师的连续横断面调查设计，我们研究了参与者的感知，安慰,使用Fisher精确检验和逻辑回归进行性别确认护理教育。
■反应率在2016年和2023年分别为68％（n=180）和69％（n=386）。与2016年相比，2023年的临床医生报告在培训期间接受相关教育的可能性显著增加。为>1名性别烦躁不安的患者提供护理，能够提供非判断性护理。2023年，26%的人报告说，由于道德问题，他们不愿意给成年人开性别确认激素(GAH)。在单变量分析中，与男性参与者相比,女性参与者更有可能报告愿意开GAH(OR=2.6,95CI=1.7~4.1).与少于4小时的人相比，处方意愿也与≥4小时的教育有关（OR=2.2，95CI=1.1-4.2），与中立者(OR=0.09,95CI=0.04-0.2)或不同意者(OR=0.11,95CI=0.03-0.39)相比,报告有能力提供非判断性护理的人.女性识别临床医生更有可能同意额外的培训将有利于他们的实践（OR=5.3，95CI=3.3-8.5）。
■尽管在2023年与2016年相比，军事附属家庭医生认可了更多的经验并愿意提供非判断性性别确认护理，但根据指定的临床医生，患者经验可能仍然存在巨大差距。应该有更多的培训机会，无法提供性别确认护理的临床医生应确保及时转诊。未来的研究应该探索临床专业的趋势。
