Centralized and Decentralized Delivery of Transgender Health Care Services: A Systematic Review and a Global Expert Survey in 39 Countries.

Introduction: Transgender health care is delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different medical institutions spread over several locations). However, the health care delivery setting has not gained attention in research so far. Based on a systematic review and a global expert survey, we aim to investigate its role in transgender health care quality. Methods: We performed two studies. In 2019, we systematically reviewed the literature published in databases (Cochrane, MEDLINE, EMBASE, Web of Science) from January 2000 to April 2019. Secondly, we conducted a cross-sectional global expert survey. To complete the evidence on the question of (de-)centralized delivery of transgender health care, we performed a grey literature search for additional information than the systematic review and the expert survey revealed. These analyses were conducted in 2020. Results: Eleven articles met the inclusion criteria of the systematic review. 125 participants from 39 countries took part in the expert survey. With insights from the grey literature search, we found transgender health care in Europe was primarily delivered centralized. In most other countries, both centralized and decentralized delivery structures were present. Comprehensive care with medical standards and individual access to care were central topics associated with the different health care delivery settings. Discussion: The setting in which transgender health care is delivered differs between countries and health systems and could influence different aspects of transgender health care quality. Consequently, it should gain significant attention in clinical practice and future health care research.

[Quality development within interdisciplinary transgender healthcare : Results and implications of a participatory research project]. / Qualitätsentwicklung in der interdisziplinären Trans-Gesundheitsversorgung : Ergebnisse und Implikationen partizipativer Versorgungsforschung.

Both internationally and nationally, the objective has been set to offer specialized, coordinated, and interdisciplinary treatment to individuals with rare clinical needs, such as trans individuals (e. g., transsexual, transgender). The Interdisciplinary Transgender Health Care Center Hamburg (ITHCCH) is the first and only center in Germany to integrate all disciplines relevant to trans healthcare (THC).The research project seeks to generate valid information to support quality development and assure high-quality treatment at the ITHCCH. This was done by (a) investigating needs and concerns of trans individuals regarding interdisciplinary THC, and (b) analyzing attitudes and interests of key stakeholders.Using a participatory approach involving a work group (representatives of trans support groups and local THC professionals), researchers developed an online survey focusing on trans individuals' needs and concerns. Data from N = 415 trans-identified participants were analyzed using quantitative and qualitative methods. In addition, a short survey was used to record key stakeholders' attitudes and interests towards the ITHCCH.Healthcare offers accessed by trans individuals as part of transition related treatment vary in focus and number. For example, take-up numbers of genital surgery differ between binary and non-binary trans individuals. Crucial aspects impacting on THC quality are structural characteristics, communication/social aspects, individuality, and professionalism/quality.To ensure successful, high-quality interdisciplinary THC, feedback from (potential) patients and stakeholders is crucial. In addition, both structural development and optimizing individuality and flexibility throughout the treatment process are key. This poses a considerable challenge to the sector of THC provision.

['How Much Sex do Medical Studies Need?' - A Survey of the Knowledge and Interest in Sexual Medicine of Medical Students.] / "Wie viel Sex braucht das Studium der Medizin?" - Eine Erhebung des Wissens und Interesses Medizinstudierender zum Thema Sexualmedizin.

Background: Because of the increasing need for medical care of problems concerning human sexuality, the International Society for Sexual Medicine (ISSM) in 2010 suggested to include sexual medicine in the current curricula of medical studies. Based on the ISSM's suggestions sexual medicine should be taught on a multidisciplinary basis throughout the whole study process. Furthermore, health care providers have repeatedly indicated that they have lacking knowledge concerning sexual medicine and patients have criticized that their health care providers only infrequently address their sexuality. Methods: 404 medical students from 2 German university medical centers answered an online questionnaire assessing the quality of sexual medicine education. The students were asked about their interest in and their knowledge about different issues concerning human sexuality in the following 4 domains: Sexual development, Sexual behavior, Sexual physiology and psychology, Sexual medicine and therapy of sexual disorders. Results: The great majority of students were interested in education about sexual medicine within medical studies, whereby most students were of the opinion that sexual medicine should be included in the already existing subjects. Furthermore, students mostly evaluated the current quality of sexual medicine education as insufficient and more than half of the students thought that they do not have enough knowledge about human sexuality for their future profession as medical health care providers. On average the students correctly answered 50% of the knowledge questions, however they showed some knowledge gaps especially in the domains of sexual development and sexual physiology and psychology. Discussion: The results of the present study suggest that medical students have lacking knowledge concerning important parts of human sexuality but at the same time express great interest in the field. Therefore, in Germany more structured educational programs in sexual medicine should be developed taking the suggestion of the ISSM into account. Conclusion: Besides medical education about pathological sexuality future educational efforts should also address healthy sexuality and its sociocultural meaning more frequently. Thereby, the students' wishes would be met and moreover, health care providers of all fields would be enabled to provide an unbiased, holistic and sensitive treatment of sexual problems.