The most recent 2023 Gallup poll found that 7.6% of Americans aged 18 and older identify with one or more LGBTQ+ groups, up from 5.6% in 2020. Despite the consistent increase over the years, the majority of Americans identify as straight or heterosexual (85.6%). This has led to well-documented health-related disparities for LGBTQ+ patients.
The lack of training and experience of providers in taking care of sexually minority patients presents a significant barrier to adequate healthcare. Improving the understanding of physicians and identifying specific healthcare concerns of the LGBTQ+ community can help facilitate and enhance the level of care.
Recommended course: Improving Access to Care for LGBTQ Patients
Barriers to healthcare for LGBTQ+ Patients
A provider’s implicit bias can lead to misconceptions about the LGBTQ+ community and lead to missed information or a failure to ask appropriate health-related questions. The biases expressed can reduce patients’ confidence in their physician and prevent them from seeking adequate care when needed.
Several additional barriers play a role in preventing LGBTQ+ patients from receiving adequate healthcare. These include lack of health insurance, existing stigma associated with LGBTQ+ lifestyles, and lack of appropriate funding for services crucial to the LGBTQ+ community.
General heteronormativity in healthcare can lead patients of differing sexual orientations and gender identifications to feel ostracized or neglected by healthcare providers. However, there are important changes one can make to improve the effectiveness and inclusiveness of their practice.
Strategies to improve healthcare access to the LGBTQ+ population
The National LGBTQIA+ Health Education Center has developed suggested alterations to promote a nonjudgmental environment for patients. Posting a non-discriminatory policy signed by staff in a public area is one suggestion to convey an inclusive environment. Additionally, the inclusion of LGBTQ+ resources within the patient education pamphlets and updated intake forms to include more inclusive options.
Create a welcoming environment for LGBTQ+ patients
Incorporating the following measures can promote a welcoming environment and encourage access to healthcare for LGBTQ+ patients.
- Display a rainbow flag, pink triangle, unisex bathroom signs, and other LGBTQ+-friendly symbols in the office.
- Hire a qualified, diverse staff to provide additional knowledge and insights into serving the LGBTQ+ community.
- Provide staff training to identify discrimination and better clarify ambiguities in a patient-centered manner.
- Clarify with patients regarding how they identify and would like to be addressed.
- Introduce oneself by incorporating your preferred pronouns and inquire about the pronouns preferred by the patient.
Developing strategies and plans to implement these suggestions will improve the comfort of your patients and the quality of care provided. Setting patients at ease early into the appointment can help facilitate the quality of information provided. It may also encourage the patient to be more forthcoming with health-related concerns.
Healthcare disparities within the LGBTQ+ community and resulting health risks
The same risk factors for health conditions exist within the LGBTQ+ community as the general population. However, these patients also face special considerations. These unique risk factors are often a result of discrimination and stigma. The following are important considerations to be aware of when caring for LGBTQ+ patients.
Minority stress
Social stresses associated with being a part of a minority group can lead to higher levels of mental health issues. They may also drive suicide, and substance abuse disorders within the LGBTQ+ community. Lack of access to resources and support can lead to increased stress and alienation of minority groups. This often further worsens mental health issues.
Alcohol, tobacco, and substance abuse
Increased stress, mental health issues, and lack of support lead to a higher incidence of alcohol, tobacco, and substance abuse disorders within the LGBTQ+ population. The Substance Abuse and Mental Health Services Administration (SAMHSA) completed a survey in 2023 indicating a two to three times higher incidence of illicit drug use in gay and bisexual males and females than their straight counterparts.
Intimate partner violence
Experts estimate that the incidence of intimate partner violence is equal or more frequent within the LGBTQ+ community compared to cis-gender individuals. This highlights the importance of incorporating gender-neutral screening tools, such as the Partner Violence Screen, in routine practice to identify these under-reported violent acts.
HIV and other sexually transmitted diseases
Many newly diagnosed cases of HIV and other sexually transmitted diseases affect LGBTQ+ patients. This highlights the importance of screening, prevention, and education to help reduce the number of new cases and improve the overall sexual health of LGTBQ+ patients.
Strategies to improve health outcomes in the LGBTQ+ community
Awareness of specific conditions and health risk factors is a step forward in improving the health outcomes of patients in the LGBTQ+ community. However, additional measures should be taken to improve care and health outcomes.
- Continuing education. Staying up to date on current national guidelines and the concerns and needs of LGBTQ+ patients is important. This will increase understanding and knowledge and decrease bias.
- Preventative care. Screening requirements are similar for all patients and each new visit should address intimate partner violence, sexual risks, substance use, and lifestyle-related safety.
- Address social and behavioral risk factors. Engage in open discussions about the risks of obesity, compliance with care, and tobacco, alcohol, and illicit drug use.
- Individualized care. Developing appropriate screening tests should be performed and care must be taken to maximize patient comfort and provide non-judgmental recommendations. This includes pap smears and prostate exams for all patients with a cervix or prostate.
- Effective communication. Use proper pronouns and avoid gender-related terms until preferences are verified with the patient.
- Increase data collection. Gathering data on the health and needs of the LGBTQ+ community will help to enhance future care and identify unmet needs.
- Address one’s own biases. Explicit and implicit biases can affect the care provided. These must be addressed periodically to improve assessments, decision-making, and the provided-patient relationships.
Non-biased care for LGBTQ+ patients
Overall, providing non-biased care and being aware of the unique challenges facing the LGBTQ+ community is essential to take care of patients. Staying current on health topics and advancing clinical knowledge is important to provide relevant recommendations for these patients. Finally, seeking continuing education with a focus on human sexuality, sexual minorities, and specific aspects of LGBTQ healthcare will improve physician knowledge and comfort while reducing biases.
