Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25437
Title: The Informed Consent Model of Care for Accessing Gender-Affirming Hormone Therapy Is Associated With High Patient Satisfaction.
Austin Authors: Spanos, Cassandra;Grace, Julian A;Leemaqz, Shalem Y;Brownhill, Adam;Cundill, Pauline;Locke, Peter;Wong, Peggy;Zajac, Jeffrey D ;Cheung, Ada S 
Affiliation: College of Medicine and Public Health, Flinders University, South Australia, Australia
Pandanus Medical NT, Millner, Northern Territory, Australia
Equinox Gender Diverse Health Centre, Thorne Harbour Health, Fitzroy, Victoria, Australia
Medicine (University of Melbourne)
Issue Date: Jan-2021
Date: 2020-11-25
Publication information: The Journal of Sexual Medicine 2021; 18(1): 201-208
Abstract: There are 2 common approaches to assess an individual before commencing of gender-affirming hormone therapy (GAHT); a mental health practitioner assessment and approval or an informed consent model undertaken with a primary care general practitioner (GP). In a primary care clinic practising an Informed Consent Model of care to initiate GAHT, we aimed to firstly describe the proportion and characteristics of patients referred for secondary consultation to a mental health practitioner (MH referred) and secondly, we aimed to measure patient satisfaction. A retrospective audit of all new patients with a transgender or gender diverse identity presenting to a primary care clinic in Melbourne, Australia was performed between March 2017 and March 2019. In those newly seeking GAHT, de-identified data were obtained including presence of secondary mental health practitioner referral, time to GAHT commencement and co-occurring mental health conditions. A separate survey assessed patient satisfaction. Mental health conditions and overall patient satisfaction in those referred for secondary mental health consultation (MH referred) were compared with those who were not (GP assessed). Of 590 new consultations, 309 were newly seeking GAHT. Referrals for secondary mental health assessment before GAHT occurred in 8%. The GP-assessed group commenced GAHT at median 0.9 months (0.5-1.8) after initial consultation compared with 3.1 months (1.3-4.0), P < .001 in the MH-referred group. The MH-referred group was more likely to have post-traumatic stress disorder (adjusted P = .036) and schizophrenia (adjusted P = .011). Of 43 respondents to the survey, a higher proportion in the GP-assessed group was extremely satisfied with their overall care compared with the MH-referred group (P < .01). Notably, 80% in the GP-assessed group chose to seek mental health professional support. Initiation of GAHT can be performed in primary care by GPs using an informed consent model and is associated with high patient satisfaction. Mental health professionals remain a key source of support. This retrospective audit did not randomize patients to pathways to initiate GAHT. Follow-up duration was short. Responder bias to survey with low response rates may overestimate patient satisfaction. This is one of the first studies to evaluate an informed consent model of care. More widespread uptake of an informed consent model of care to initiate GAHT by primary care physicians has the potential for high patient satisfaction and may be a practical solution to reduce waiting lists in gender clinics. Spanos C, Grace JA, Leemaqz SY, et al. The Informed Consent Model of Care for Accessing Gender-Affirming Hormone Therapy Is Associated With High Patient Satisfaction. J Sex Med 2020;XX:XXX-XXX.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25437
DOI: 10.1016/j.jsxm.2020.10.020
ORCID: 
Journal: The jJournal of Sexual Medicine
PubMed URL: 33249011
Type: Journal Article
Subjects: Gender-Affirming Hormone Therapy
Informed Consent Model
Mental Health
Transgender
Appears in Collections:Journal articles

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