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Assessment of Patient-Centered Approaches to Collect Sexual Orientation and Gender Identity Information in the Emergency Department: The EQUALITY Study.
Haider, Adil; Adler, Rachel R; Schneider, Eric; Uribe Leitz, Tarsicio; Ranjit, Anju; Ta, Christina; Levine, Adele; Harfouch, Omar; Pelaez, Danielle; Kodadek, Lisa; Vail, Laura; Snyder, Claire; German, Danielle; Peterson, Susan; Schuur, Jeremiah D; Lau, Brandyn D.
Afiliação
  • Haider A; Center for Surgery and Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Adler RR; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Schneider E; School of Medicine and Public Health, University of Wisconsin, Madison.
  • Uribe Leitz T; University of Virginia, Charlottesville.
  • Ranjit A; Center for Surgery and Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Ta C; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Levine A; Center for Surgery and Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Harfouch O; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Pelaez D; Center for Surgery and Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Kodadek L; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Vail L; Center for Surgery and Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Snyder C; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • German D; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Peterson S; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Schuur JD; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Lau BD; Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Netw Open ; 1(8): e186506, 2018 12 07.
Article em En | MEDLINE | ID: mdl-30646332
ABSTRACT
Importance Health care and government organizations call for routine collection of sexual orientation and gender identity (SOGI) information in the clinical setting, yet patient preferences for collection methods remain unknown.

Objective:

To assess of the optimal patient-centered approach for SOGI collection in the emergency department (ED) setting. Design, Setting, and

Participants:

This matched cohort study (Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity [EQUALITY] Study) of 4 EDs on the east coast of the United States sequentially tested 2 different SOGI collection approaches between February 2016 and March 2017. Multivariable ordered logistic regression was used to assess whether either SOGI collection method was associated with higher patient satisfaction with their ED experience. Eligible adults older than 18 years who identified as a sexual or gender minority (SGM) were enrolled and then matched 1 to 1 by age (aged ≥5 years) and illness severity (Emergency Severity Index score ±1) to patients who identified as heterosexual and cisgender (non-SGM), and to patients whose SOGI information was missing (blank field). Patients who identified as SGM, non-SGM, or had a blank field were invited to complete surveys about their ED visit. Data analysis was conducted from April 2017 to November 2017.

Interventions:

Two SOGI collection approaches were tested nurse verbal collection during the clinical encounter vs nonverbal collection during patient registration. The ED physicians, physician assistants, nurses, and registrars received education and training on sexual or gender minority health disparities and terminology prior to and throughout the intervention period. Main Outcomes and

Measures:

A detailed survey, developed with input of a stakeholder advisory board, which included a modified Communication Climate Assessment Toolkit score and additional patient satisfaction measures.

Results:

A total of 540 enrolled patients were analyzed; the mean age was 36.4 years and 66.5% of those who identified their gender were female. Sexual or gender minority patients had significantly better Communication Climate Assessment Toolkit scores with nonverbal registrar form collection compared with nurse verbal collection (mean [SD], 95.6 [11.9] vs 89.5 [20.5]; P = .03). No significant differences between the 2 approaches were found among non-SGM patients (mean [SD], 91.8 [18.9] vs 93.2 [13.6]; P = .59) or those with a blank field (92.7 [15.9] vs 93.6 [14.7]; P = .70). After adjusting for age, race, illness severity, and site, SGM patients had 2.57 (95% CI, 1.13-5.82) increased odds of a better Communication Climate Assessment Toolkit score category during form collection compared with verbal collection. Conclusions and Relevance Sexual or gender minority patients reported greater comfort and improved communication when SOGI was collected via nonverbal self-report. Registrar form collection was the optimal patient-centered method for collecting SOGI information in the ED.
Assuntos

Texto completo: 1 Temas: ECOS / Aspectos_gerais / Equidade_desigualdade Bases de dados: MEDLINE Assunto principal: Coleta de Dados / Pessoal de Saúde / Assistência Centrada no Paciente / Serviços Médicos de Emergência / Minorias Sexuais e de Gênero Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: JAMA Netw Open Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Temas: ECOS / Aspectos_gerais / Equidade_desigualdade Bases de dados: MEDLINE Assunto principal: Coleta de Dados / Pessoal de Saúde / Assistência Centrada no Paciente / Serviços Médicos de Emergência / Minorias Sexuais e de Gênero Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: JAMA Netw Open Ano de publicação: 2018 Tipo de documento: Article