Quality of Care

Very little research has been conducted on the quality of care experienced by sexual and gender minorities. A limited amount of research has explored the preferences of lesbian, gay, and bisexual patients with respect to receiving care. Findings indicate that satisfaction among sexual-minority patients is associated with a number of factors, including the provider’s LGB-specific knowledge, the competency of care, and sensitivity to areas of concern for sexual minorities (Burckell and Goldfried, 2006; Saulnier, 2002; Seaver et al., 2008). Page (2007) explored self-identified bisexual men and women’s (n = 217) experiences with psychotherapy and found that respondents viewed knowledge of bisexual-specific issues and validation of bisexual identity as important to a positive patient–provider relationship. As mentioned above, some research suggests that the quality of care received by transgender people is affected by a lack of culturally competent providers (Bockting et al., 1998; Clements-Nolle et al., 1999; Sperber et al., 2005). In a convenience sample of 122 female-to-male transgender persons ranging in age from 18 to 60, Rachlin and colleagues (2008) found mixed reviews of health care services. About one-third of respondents rated the care they received as either poor or fair; about one-quarter rated their health care provider’s sensitivity to their needs as “a trans person” as either “horrible” or poor or fair.

Some literature examines specific care environments for LGBT populations. For example, Brown and McDuffie (2009) surveyed prison systems in the United States regarding the care provided to transgender inmates. They found wide variability in terms of access to sex hormones, with some systems allowing continuation of treatment, some requiring that hormone treatment be stopped, and others allowing the initiation of treatment. In a survey of substance abuse services specializing in LGBT clients, Cochran and colleagues (2007b) found no difference between the specialized services offered to LGBT clients and those offered to the general population. These studies are limited by their lack of generalizability, however.

At the University of Minnesota, results from five consecutive patient satisfaction surveys over a 10-year period showed that satisfaction with transgender-specific health care services was high (Bockting et al., 2004). Few significant differences were found between transgender patients (n = 180) and other sexual health patients (n = 837), except that in one year, transgender patients reported higher satisfaction on their perceived ability to handle the problems that originally had led them to seek services. This is one of the very few studies examining patient satisfaction with the delivery of transgender-specific health care, and it indicates that, despite the challenges associated with the gate-keeping role (i.e., the requirement for evaluation and recommendation from a mental health



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