Readiness to provide pharmaceutical care to transgender patients: Perspectives from pharmacists and transgender individuals

Pharmaceutical Education in LGBTQIA+ Healthcare: A Scoping Review of Educational Strategies and Barriers

OBJECTIVE

To map and describe training and educational strategies and identify barriers faced in pharmaceutical education on LGBTQIA+ healthcare.

METHODS

A comprehensive search was performed in PubMed, Scopus, LILACS, and Google Scholar until December 2023. Publications evaluating pharmaceutical education for students or pharmacists on LGBTQIA+ health topics were included. Two authors independently performed the study selection and data extraction.

RESULTS

A total of 26 studies were included, mostly focusing on transgender individuals (n = 14) and conducted in the United States (n = 19) within the last seven years (n = 23). The majority were cross-sectional (n = 14) and targeting pharmacy students (n = 14). Educational strategies in LGBTQIA+ healthcare included primarily lectures (n = 7), clinical case-based learning (n = 6), and panels with LGBTQIA+ individuals (n = 4). Advanced strategies like role-play and OSCE were used exclusively with pharmacy students (n = 4). Identified barriers included a lack of curriculum space (n = 11), minimal exposure to LGBTQIA+ patients (n = 6), limited contact with the subject during formal education and training (n = 6), and a shortage of qualified professionals to teach LGBTQIA+ topics (n = 5).

CONCLUSION

This review highlights the need to integrate LGBTQIA+ health topics into pharmacy curricula and continuing education through active learning strategies to develop advanced competencies. Addressing curriculum space limitations, increasing exposure to LGBTQIA+ patients, and enhancing the availability of qualified educators are essential to ensure pharmacists are well-prepared to provide inclusive and effective care to LGBTQIA+ individuals.

Pharmacy barriers for transgender and gender diverse young adults

BACKGROUND

Transgender and gender diverse (TGD) individuals face substantial physical and mental health care barriers. Community pharmacies are one of the most accessible health care settings; however, concern for discrimination at the pharmacy has been reported. It is important to gain a better understanding of TGD individual's perspectives and experiences at the pharmacy to ensure optimal and inclusive care.

OBJECTIVE

To identify TGD individual experiences and barriers at the pharmacy.

METHODS

This institutional review board-approved qualitative study recruited TGD young adults in the United States between ages 18 and 29 years for semi-structured focus group discussions. Questions focused on barriers to obtaining medications at the pharmacy and negative or positive experiences with pharmacists. Interviews were recorded, transcribed, and transcripts were analyzed for common themes amongst participants.

RESULTS

Nine 1.5- to 2-hour focus groups were conducted and included 30 participants (2-6 participants in each group). All participants reported having been prescribed medications by a physician or mental health provider. Participants self-reported issues at pharmacies and with pharmacy personnel. Major themes included issues accessing medications and supplies (needles, syringes), questioning of prescription validity and patient identity, and lack of education or understanding of TGD individuals by pharmacy staff.

CONCLUSION

TGD individuals experience barriers at the pharmacy and concerning issues with pharmacy staff. Education, structural competency, and improvements in gender-related data management are necessary for pharmacists and pharmacy staff to provide equitable and inclusive care for TGD individuals.

Informing inclusive and affirmative hospital pharmacy services for 2SLGBTQ+ patients

PURPOSE

Two-spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) people disproportionally experience health disparities, and hospital pharmacists, given their accessibility and expertise in medication management, are ideally positioned to provide care to this vulnerable population. This study investigated the barriers and facilitators faced by hospital pharmacists when providing care to 2SLGBTQ+ patients, with the goal of informing enhancement of quality care provided to these patients.

METHODS

A mixed-methods triangulation design was utilized, comprising an online survey and qualitative interviews with Canadian hospital pharmacists. The survey used the lens of systemic oppression as a framework and assessed pharmacists' perceptions and knowledge. Survey data were analyzed using descriptive statistics, and interviews were analyzed using thematic analysis.

RESULTS

A total of 129 individuals participated in the survey, and 15 participants were interviewed. Eleven themes were identified, and findings revealed a complex web of individual, interpersonal, and systemic barriers and facilitators. Pharmacists expressed a lack of proficiency and confidence in discussing 2SLGBTQ+ health topics, further compounded by an apprehension to engage and a fear of causing harm. Pharmacists desired support from their leadership teams and organizations in the form of access to resources, time to engage in training, and workplace environments that encourage discussions about 2SLGBTQ+ health.

CONCLUSION

Hospital pharmacists in Canada are willing to provide inclusive care to 2SLGBTQ+ patients but face significant barriers. These findings highlight the need for comprehensive education, supportive workplace cultures, and accessible resources to address health disparities and improve care for 2SLGBTQ+ individuals.

An exploratory mixed-methods evaluation of continuing education opportunities related to the care of sexual and gender minority patients from ACPE-accredited providers

PURPOSE

The objective of this analysis was to describe trends in continuing education opportunities for pharmacy professionals across the US related to the care of sexual and gender minority (SGM) patients.

METHODS

Continuing education programs offered by Accreditation Council for Pharmacy Education (ACPE)-accredited providers from 2012 through 2022 were identified by searching the ACPE database for titles containing SGM terminology. Data including ACPE provider classification, activity type, format, audience, ACPE topic designator, interprofessional accreditation, contact hours, and learning objectives were collected. Content analysis was used to categorize activities.

RESULTS

Following removal of duplicates and non-SGM-focused programming, 726 programs were identified. The most commonly observed program characteristics included a live format (67.6%, n = 491), a pharmacist audience (77.1%, n = 560), knowledge-based activities (90.8%, n = 656), a college or school of pharmacy provider (21.6%, n = 157), an ACPE topic of pharmacy administration (50.6%, n = 367), and a focus on pharmacy rather than interprofessional audiences (87.1%, n = 632). The median program length was 1 hour (interquartile range, 1-1.25 hours). The qualitative analysis identified programs focused on topics of gender-affirming care (pharmacotherapy) (32.1%, n = 233), general SGM (26.7%, n = 194), gender-affirming care (nonpharmacotherapy), sexually transmitted infections (7.2%, n = 52), and health disparities (3.9%, n = 28).

CONCLUSION

Advancement has occurred in the number of available continuing pharmacy education programs focused on the care of SGM patients. Further information regarding specific content and effectiveness of continuing education is necessary to determine strategies to better prepare pharmacy professionals to care for this growing patient population.

Experiences of Latinx sexual and gender minorities with access to healthcare during COVID-19 stay-at-home orders

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic affected all social systems, but healthcare services were particularly disrupted. The pandemic also had a disproportionate impact on populations made socially vulnerable. In this study, we documented the experiences of Latinx sexual and gender minority (SGM) individuals with access to care during COVID-19 stay-at-home orders.

METHODS

Semistructured qualitative interviews assessing experiences during the stay-at-home orders in response to the COVID-19 pandemic and patients' experiences accessing healthcare during this period were conducted with 21 Latinx SGM individuals from the Washington, DC, area. Data were analyzed using rapid qualitative analysis (RQA), and salient themes were identified.

RESULTS

The RQA revealed 3 themes reflecting participants' experiences with pharmaceutical care during COVID-19 stay-at-home orders: (1) challenges in accessing HIV services; (2) community engagement; and (3) providers supporting access to care. Participants experienced problems with adherence to medication, transportation, and technology, as well as delays in care and miscommunication with providers. Latinx SGM individuals demonstrated engagement in response to this emergency as a community and valued their providers and their efforts to facilitate access to care.

CONCLUSION

The COVID-19 pandemic strained healthcare services. Findings from this study show that the impact of the pandemic on the provision of care increased the vulnerability of Latinx SGM people. Future research should explore the impact of public health emergencies on the health of populations historically made socially vulnerable, and innovative solutions should be identified to eliminate these barriers to health equity.

Evaluation of a transgender health training program for pharmacists and pharmacy students in Australia: A pre-post study

Background

Disparities in healthcare for transgender and gender diverse (TGD) people are well-recognized, with pharmacists reporting a lack of knowledge impacting confidence in their interactions with TGD people. Therefore, a training program in TGD healthcare was designed to address this knowledge gap.

Objective

To evaluate the impact of the TGD healthcare training program on the awareness, knowledge, and behaviour of pharmacists and pharmacy students in Australia.

Method

An online training program was evaluated by pre-and post-test surveys, which assessed the knowledge and awareness of participants, and three-month post-training interviews, which examined the effect of training on pharmacists' practice when providing care to TGD people. Data were analyzed using paired t-tests, content and thematic analysis.

Result

Fifty-six pharmacists and twenty-one pharmacy students completed the training and pre-and post-test surveys. Ten pharmacists were interviewed post-training. There was a significant improvement in the awareness (pharmacists, p ≤0.001; students, p = 0.006), knowledge (pharmacists and students, p ≤0.001) and total (pharmacists and students, p ≤0.001) post-test scores for both groups. Interviewed participants found the training program comprehensive and relevant to their practice.

Conclusion

This study has demonstrated that educational interventions improve TGD healthcare awareness and knowledge for pharmacists and students with the potential to improve healthcare provision to TGD people and promote inclusivity in society.

Exploring LGBTQ+ cultural competency and DEI in continuing education: A cross-sectional review of U.S. pharmacy legislation

BACKGROUND

Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, or other sexual orientations or gender identities (LGBTQ+) cultural competency training is offered in pharmacy curricula to variable extents. State legislation directly dictates pharmacist training through continuing pharmacy education (CPE) requirements.

OBJECTIVES

This study aimed to identify the U.S. states and the District of Columbia (D.C.) that require CPE or training on topics related to LGBTQ+ cultural competency or topics related to diversity, equity, and inclusion (DEI) in general. In addition, this study quantified and compared each state's CPE hours required for each renewal period.

METHODS

This cross-sectional study retrospectively examined pharmacy legislation on CPE requirements for each of the 50 U.S. states and D.C. Only state legislation that was signed into law and related to pharmacy practice was included. Official websites for each board of pharmacy were identified to locate lawbooks, laws, rules, regulations, and statutes specific to pharmacy practice. Search terms included "lgbt," "lgbtq," "cultural," "cultural competency," "equity," "health equity," "implicit," and "implicit bias." Two study investigators independently collected data from March 2023 to April 2023. Data were re-reviewed for accuracy in January 2024. Discrepancies were resolved through discussion until a consensus was reached. The total number of required CPE hours, years for each pharmacist license renewal, required LGBTQ+ cultural competency CPE hours, and required DEI-focused CPE hours were described using descriptive statistics.

RESULTS

A total of 44 of 51 states and D.C. required 30 CPE hours for each 2-year renewal cycle or 15 CPE hours for each 1-year renewal cycle. California and D.C. had LGBTQ+ cultural competency CPE requirements of 1 CPE hour or 2 CPE hours per cycle, respectively. Five additional states, Illinois, Maryland, Michigan, Oregon, and Washington, required training or CPE on topics related to DEI as a whole.

CONCLUSION

Few U.S. states require CPE on LGBTQ+ cultural competency. This study highlights the need for standardized pharmacist training in LGBTQ+ health care.

Do the attitudes and practices of Australian pharmacists reflect a need for education and training to provide care for people who are transgender?

BACKGROUND

Many transgender and gender diverse (TGD) people access care through community pharmacy in Australia. However, there is limited information available about the role of Australian pharmacists in providing care for TGD people.

OBJECTIVE

To explore the attitudes, practices, and training needs of pharmacists in the provision of care for TGD people in Australia.

METHOD

Pharmacists Australia-wide were invited to participate in an online survey through Facebook, e-newsletters of pharmacy organizations and a professional pharmacy journal. Quantitative data were analysed for descriptive and inferential statistics. A Fisher exact test was used to investigate associations between two variables. Results with P value <0.05 were considered statistically significant. Content analysis was used to analyse data from free-text responses.

RESULT

Of the 169 respondents, the majority were female (75.1%), aged below 40 years (74%) and with less than 10 years of working experience as a pharmacist (58%). Although 95% of the sample agreed that they had an important role in the provision of care for TGD people, only 29.6% were confident about their knowledge of pharmacotherapeutic treatments for gender affirmation. Only 2.4% had received education about TGD care at university, and only 5.3% received any TGD healthcare training over the past 5 years.

CONCLUSION

Although pharmacists had a positive attitude and recognized their role in TGD care, they expressed a lack of confidence in their knowledge to be a barrier to providing quality care. Most recommended the need for more education about TGD healthcare in pharmacy curricula and continuous professional education activities.

Answering the Call for Community Pharmacists to Improve Healthcare Delivery to Trans and Gender Diverse People: Guide for Designing, Implementing, and Evaluating an Online Education Program in Australia

BACKGROUND

Trans and gender-diverse people visiting pharmacies may not always receive optimum care due to pharmacists' lack of knowledge and confidence to provide such care. This situation prompts a need for training.

OBJECTIVES

This paper aimed to describe a guide to the design, implementation, and evaluation of a training program on transgender healthcare for pharmacists in Australia.

METHODS

The Implementation Mapping Framework provided a foundation for the design, implementation, and evaluation of this training program. Through active involvement in the program development, trans and gender diverse people and pharmacists guided the program design, ensuring alignment with the cultural, social, and healthcare contexts.

RESULTS

The needs analysis highlighted the necessity for training for pharmacists to improve their cultural awareness and pharmacotherapeutic knowledge about transgender healthcare. Applying a novel Gender Inclusivity in Pharmacy Framework, online modules-(1) Transgender healthcare-language, terminology, and key healthcare issues, (2) Gender-affirming therapies, and (3) Case studies in transgender healthcare-were developed to enable the implementation of a training program.

CONCLUSION

The Implementation Mapping Framework and the Gender Inclusivity in Pharmacy Framework proved effective tools for providing an education program for pharmacists.

A Resource Compendium for Embedding LGBTQIA+ Patient Care in the Professional Identity of Community Pharmacists

OBJECTIVES

Cultural, clinical, social, and legally competent patient care for lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) patients is currently scarcely incorporated in pharmacy curricula. Furthermore, clinical, legal, and socio-cultural training that prepares pharmacists on the job to provide LGBTQIA+ competent patient care is scant. Here, our objectives were to (1) systematically review the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify trends in community pharmacists' professional identity development related to the provision of competent LGBTQIA+ patient care, and (2) create a reference guide for community pharmacists for self-directed learning. The literature search focused on 4 professional identity domains common to most pharmacists: academic and clinical competence, cultural sensitivity, knowledge of state and federal laws, and continuing professional development.

FINDINGS

A total of 207 articles were identified, with 93 retrieved, of which 26 articles were included in the final analysis based on title and abstract and other inclusion criteria.

SUMMARY

Overall, our search identified that the LGBTQIA+ health professions literature focused on the following themes: guidance for appropriate drug selection and therapy, creation of cultural sensitivity training curricula, community pharmacists' perceptions of their ability to provide LGBTQIA+ care, health system interventions, and Allyship education for advancing LGBTQIA+ care, the need for enhanced training of pharmacists for understanding the federal and state laws and requirements while providing care, and the need for a resource compendium to help community pharmacists access self-directed learning information, for which we have created a self-help resource guide for pharmacists in these 4 professional pharmacist identity domains.

Ohio community pharmacists' provision of inclusive care for transgender and gender-diverse patients

BACKGROUND

Community pharmacists have potential challenges to overcome to care for transgender and gender-diverse patients properly. The American Pharmacists Association and Human Rights Campaign released a resource guide in March 2021 with best practices for gender-affirming care, yet there are no reports of community pharmacists' awareness or implementation of the guide.

OBJECTIVES

This study's primary objective was to assess community pharmacists' awareness of the guide. Secondary objectives were to determine whether their current practices align with the guide's recommendations and whether they are interested to learn more information.

METHODS

An anonymous, institutional review board-approved survey developed from the guide's framework was e-mailed to 700 randomly selected Ohio community pharmacists. As an incentive, respondents could select a charitable organization to receive a donation.

RESULTS

Of the 688 pharmacists receiving the survey, 83 completed it (12%). Only 10% were aware of the guide. A range in self-reported ability to define key terms was found, from 95% for "transgender" to 14% for "intersectionality." Among the guide's suggested practices, collection of preferred names (61%) and consideration of transgender, gender-diverse, or nonheterosexual patients in their staff training (54%) were most often reported. Fewer than 50% reported pharmacy software with key gender-related data management capabilities. Most respondents indicated an interest in learning more about components of the guide, but gaps remained.

CONCLUSION

There is a need to raise awareness of the guide and to provide foundational knowledge, skills, and tools to ensure culturally competent care for transgender and gender-diverse patients and improve health equity.

Students' knowledge, comfort, attitudes, and training on oral health of transgender individuals: A pilot study

PURPOSE

The purpose of this pilot study was to evaluate students' knowledge, comfort, attitudes, and formal training on oral health of transgender individuals.

METHODS

A single-site cross-sectional study of 223 students from four educational programs were invited to participate in this study. A 17-item survey was modified from two previous instruments with permission. The electronic survey was disseminated via Google Forms two times 6 weeks a part. Analyses were conducted using R version 4.1.1. Survey responses were summarized as means and standard deviations. Comparisons of survey responses by program type, age group, prior degree, and gender were performed using the chi-square test for association and analysis of variance.

RESULTS

A total of118 completed the survey for a 53% response rate. Students disagreed (26.3%) they had knowledge on hormone treatments or non-hormonal treatment (40.7%) and strongly disagreed (40.7%) they had knowledge on oral manifestations of hormonal or non-hormonal therapies. Students strongly agreed they are comfortable treating transgender patients (63.6%) and believe it is the responsibility of all healthcare providers to care for transgender patients (83.1%). Students disagreed they are prepared to care for transgender patients (40.7%) or that their faculty demonstrate competency caring for transgender patients undergoing hormonal treatment (21.4%).

CONCLUSION

Students are comfortable providing oral health care to transgender individuals and feel a responsibility to care for them. Formal training on hormonal and non-hormonal therapy for transgender individuals is needed in dental education programs to enhance students' knowledge and faculty competence.

Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care

Marginalised people experience diminished access to pharmaceutical care and worse medication-related outcomes than the general population. Health equity is a global priority. This article explores the key evidence of health inequity and medication use, structures the causes and contributory factors and suggests opportunities that can be taken to advance the pharmaceutical care agenda so as to achieve health equity. The causes of, and contributors to, this inequity are multi-fold, with patient- and person-related factors being the most commonly reported. Limited evidence is available to identify risk factors related to other aspects of a personal medication use system, such as technology, tasks, tools and the internal and the external environments. Multiple opportunities exist to enhance equity in medication-related outcomes through pharmaceutical care research and practice. To optimise the effects and the sustainable implementation of these opportunities, it is important to (1) ensure the meaningful inclusion and engagement of members of marginalised groups, (2) use a person-centred approach and (3) apply a systems-based approach to address all of the necessary components of a system that interact and form a network as work processes that produce system outcomes.

“I don't know much about providing pharmaceutical care to people who are transgender”: A qualitative study of experiences and attitudes of pharmacists

Background

Globally, with the increased visibility, the number of transgender people accessing healthcare services has risen in the last decade. Although pharmacists are required to provide equitable and respectful care to all patients, their experiences interacting with trans and gender-diverse (TGD) people and attitudes towards the provision of care are largely unknown.

Objectives

This study aimed to determine the experiences and attitudes of pharmacists providing care to TGD people in Queensland, Australia.

Methods

Within a transformative paradigm, this study used semi-structured interviews conducted in person, over the phone, or through the Zoom app. Data were transcribed and analyzed by applying the constructs of the Theoretical Framework of Accessibility (TFA).

Results

A total of 20 participants were interviewed. Analysis revealed all seven constructs across interview data, with affective attitude and self-efficacy being the most frequently coded constructs, followed by burden and perceived effectiveness. The least coded constructs included ethicality, intervention coherence, and opportunity cost. Pharmacists had positive attitudes towards providing care and interacting professionally with TGD people. Prime challenges in delivering care were being unaware of inclusive language and terminology, difficulty building trusted relationships, privacy and confidentiality at the pharmacy, inability to locate appropriate resources, and lack of training in TGD health. Pharmacists felt rewarded when they established rapport and created safe spaces. However, they requested communication training and education to improve their confidence in delivering care to TGD people.

Conclusion

Pharmacists demonstrated a clear need for further education on gender-affirming therapies and training in communication with TGD people. Including TGD care in pharmacy curricula and continuous professional development activities is seen as an essential step towards pharmacists improving health outcomes for TGD people.

Taking Action Towards Equity, Diversity, and Inclusion in the Pharmacy Curriculum and Continuing Professional Development

Increased awareness of social injustices and inequities highlight the relevance and importance of diversity, equity, inclusion, and accessibility (DEIA) in health care. Former and recent graduates of pharmacy schools remain deficient in their knowledge of DEIA topics such as unconscious bias, which can directly influence health outcomes in an undesirable manner. Particular DEIA areas that are pertinent to pharmacy practice include: race, gender, sexual orientation, gender identity, ability status, religion, socioeconomic status, and political beliefs. The American Association of Colleges of Pharmacy (AACP) affirmed its commitment to DEIA as a priority. However, existing gaps in knowledge of pharmacy graduates in this area have the potential to contribute to health disparities and inequities, which are significant public health issues. We call on academic pharmacy institutions and professional pharmacy organizations to elevate DEIA topics and to designate them as essential to both addressing health equity and improving care for underserved populations. We also implore licensing boards to require continuing education related to DEIA as a foundational step to closing the knowledge gap for pharmacists in this area.

Exploring pharmacists' understanding and experience of providing LGBTI healthcare

Background

Lesbian, gay, bisexual, transgender and intersex (LGBTI) people experience health and wellness challenges additional to and separate from those of the wider population. Extant research has identified that LGBTI patients support education for healthcare providers to improve their access to appropriate care. Community pharmacists have a role in providing appropriate care to LGBTI patients.

Aims

This study explores the experiences of Australian community pharmacists in providing LGBTI healthcare.

Methods

Ten pharmacists were interviewed using a semi-structured interview guide and the major themes were identified using Braun and Clark's thematic analysis.

Results

Analysis revealed a demand for professional education in several areas of LGBTI healthcare, especially gender-affirming hormone replacement therapy and safe communication with this group. Barriers to privacy and confidentiality were revealed, including time constraints, Covid-19 social distancing requirements, and the lack of appropriate consultation rooms. Further there is a need to engage LGBTI patients through greater inclusive advertising.

Conclusions

While there is some improvement, more must be done to promote inclusive pharmacy care for LGBTI people. This study demonstrates a demand from Australian pharmacists for increased professional education on LGBTI related healthcare.

Advancing the conversation: A review of scholarly activity for curricular interventions for sexually- and gender-diverse patients in pharmacy education

BACKGROUND

Educational interventions are required to train pharmacists to provide culturally safe care to sexually- and gender-diverse patients. Programming must promote inclusivity and should also focus on systemwide change. The aim of this review was to identify, summarize, and map scholarly activity with respect to lesbian, gay, bisexual, transgender, queer, plus (LGBTQ+) health in entry-to-practice pharmacy curricula.

METHODS

An electronic search of Medline, EMBASE, and International Pharmaceutical Abstracts was conducted to search for relevant literature up to May 2021. This search was supplemented with a keyword search of three pharmacy education journals. Articles were included in the review if they described an educational intervention for entry-to-practice pharmacy students related to health for sexually- or gender-diverse patients.

RESULTS

Five articles met inclusion criteria. All articles reported interventions relating to gender-diverse patients. One reported interventions relating to sexually-diverse patients and another was deemed unclear. Four articles reported single teaching events or short modules, and one article reported a full course. Incorporating real patients into teaching events to share their experiences with the health system was consistently received positively by students.

IMPLICATIONS

Scholars involved in developing and implementing educational interventions related to health for sexually- and gender-diverse patients should be encouraged to contribute to the scholarly conversation by sharing successful experiences, as well as lessons learned. Future areas of expansion include integration of sexual and gender minority health across curricula and including content to prepare students for implementing and supporting systemwide change.

Knowledge, attitudes, and willingness of oral health professionals to treat transgender patients

Background

Lack of knowledge about transgender patients often correlates with increased stigma and an unwillingness to provide care to this population. This study examined the knowledge, attitudes, and willingness of oral health care providers with regard to treating transgender patients.

Methods

Dentists, mid-level providers, and dental hygienists in the United States and Canada accessed an online survey (N = 315) focused on assessing knowledge, attitudes, and willingness to provide care and/or seek additional education on treating transgender individuals. Descriptive statistical, correlational, and regression analyses were conducted.

Results

The survey completion rate was 85% (n = 268). Respondents correctly answered an average of 70% of the knowledge questions, with 56% of participants unable to define "gender" and 66% unable to define "sex identity". Almost 1 in 4 respondents incorrectly defined a trans male or trans female, or misidentified particular health disparities experienced by transgender individuals. A lack of willingness to seek additional information on providing culturally competent care, having lower levels of knowledge, and identifying with specific religions correlated with higher levels of stigma (p < 0.001). While US providers exhibited low stigma overall, Canadian providers, survey respondents with higher levels of knowledge, and those with transgender friends and/or family demonstrated lower levels of stigma (p < 0.001).

Discussion and conclusions

Transgender individuals face disparities in medical and oral health care. Based on the findings of this survey, it will be important to address factors associated with higher levels of stigma and educate oral health professionals on providing culturally competent care for transgender individuals.

Pharmacists' role in transgender healthcare: A scoping review

BACKGROUND

Transgender patients have unique healthcare needs, providing pharmacists with the opportunity to play an important role in transgender care through addressing the healthcare disparities observed in this patient group.

OBJECTIVE

This scoping review aimed to explore the role of pharmacists in transgender healthcare.

METHODS

Six databases were searched from inception: Emcare, Informit, MEDLINE (Ovid), PubMed, Scopus, and Web of Science. The first author performed screening and data extraction in consensus with co-authors. Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was utilised to report this review. Themes related to the role of pharmacists in transgender healthcare were identified.

RESULTS

A total of 356 studies were identified; however, only 15 studies, all from the USA met the selection criteria and were included in this review. Study types included empirical research, practice reports and opinion pieces such as commentaries, editorials, and reports. Pharmacists were found to practise in two different care settings: community and interdisciplinary clinics, performing various roles in transgender healthcare, including patient education and counselling, management of cross-sex hormonal therapy, patient advocacy and provision of preventative care. They were also responsible for the provision of culturally sensitive care in an inclusive and welcoming environment. Although pharmacists considered their role important, they lacked confidence in their knowledge to provide appropriate care to this patient group.

CONCLUSION

This review has highlighted that there is a need for education in transgender care for both pharmacists and pharmacy students, so that they are both confident and comfortable to play a meaningful role in transgender care. Pharmacists' involvement in addressing the health disparities experienced will contribute to improving the overall health outcomes for this group.

Pharmacists perceptions and preparedness regarding gender-affirming hormone therapy

BACKGROUND

As the transgender and gender non-conforming (TGNC) population in the United States continues to grow, there is a need for health care providers who are competent in managing gender-affirming therapy (GAT) for these individuals.

OBJECTIVES

The purpose of this study was to assess practicing pharmacists' readiness to care for transgender and gender nonconforming (TGNC) patients and to compare the perceptions between pharmacists who have received formal education about gender-affirming therapy (GAT) and those who have not received such training.

METHODS

This was a cross-sectional study that was conducted online over 4 weeks (January 2019-February 2019). A survey was distributed to pharmacists in the United States. Distribution of the survey was conducted through professional pharmacy social media groups. Respondents were asked to anonymously rate their perceived preparedness to care for a TGNC patient and to disclose any formal GAT training they had received during pharmacy school or through continuing pharmacy education. Responses were further stratified on the basis of self-reported completion of GAT education taken after pharmacy school. The responses of those who had received GAT training were compared with the responses of those who had not received GAT training.

RESULTS

The results of this survey indicated that few pharmacists felt prepared to care for TGNC patients. Furthermore, few pharmacists report receiving formal education over GAT during pharmacy school or postgraduation. Approximately 41% and 40% of respondents, respectively, reported that they did not feel prepared to make recommendations to other health care providers on GAT and counsel TGNC patients about GAT regimens. However, the self-reported GAT-trained pharmacists showed a significantly increased level of perceived preparedness in caring for TGNC patients when compared with pharmacists who did not receive such education.

CONCLUSION

Increased accessibility to GAT education for pharmacists may be associated with a significant growth in pharmacists' perceived ability to provide care for and interact with transgender patients.

Educational intervention to improve pharmacist knowledge to provide care for transgender patients

BACKGROUND

Most pharmacists have not received formal training or education in the provision of care for transgender patients. Nonetheless, pharmacists have the potential to be valuable partners in the care of transgender patients, and a continuing education course might be valuable in addressing this knowledge gap.

OBJECTIVE

The aim of this study was to examine the impact of a three-hour continuing education course in improving the knowledge of pharmacists to provide pharmaceutical care for transgender patients.

METHODS

A quasi-experimental, one-group pre-test/post-test study design was used to measure the impact of a three-hour continuing pharmacy education course on the knowledge of pharmacists on transgender care. The course was divided into three units: (1) Transgender Patient Care Introduction, (2) General Health Issues of Transgender Patients, and (3) Gender Affirming Hormone Therapy. A total of 68 pharmacists participated in the study, of which 54 completed both the pre- and post-test. An ANOVA was used to compare differences in knowledge in the group before and after the educational intervention.

RESULTS

The majority of the participating pharmacists were cisgender, heterosexual women who had not received any formal training related to transgender care. Participants demonstrated the largest increase in execution score in the third unit, with a percent improvement of 25.22% (pre-test 45.06%, post-test 70.28%; p<0.001). The average total execution score was 52.15% in the pre-test and 72.89% (p< 0.001) in the post-test.

CONCLUSIONS

Pharmacists benefited from a three-hour continuing education course with an increase in knowledge regarding transgender patient care and hormone therapy for gender affirmation. As this study only evaluated the effect in short term memory, further studies are needed to assess long term impact of the continuing education course on transgender care knowledge.

The Development of a Knowledge Test on Transgender Patients' Care

The objective of this study was to develop an assessment instrument to measure the effects of a continuing education intervention on 3 domains in pharmacists' knowledge needed to provide pharmaceutical care for transgender patients: (1) foundations of gender-affirming care, (2) health disparities and the specific needs of transgender patients, and (3) hormone treatments for transgender patients. Multiple-choice questions were developed, and an initial item bank of 47 items was drafted. Item bank revision was conducted by content matter experts, while feedback from 8 practicing pharmacists was provided for face validity and further insights. A preliminary test, containing 42 items was administered to 64 pharmacists before and after a three-hour continuing education intervention. Cronbach's alpha coefficient yielded a value of 0.65 as a pre-test and 0.77 as a post-test. Items were less difficult to answer by participants after taking the three-hour continuing education, showing better discrimination among high and low performers in the instrument administration as post-test, as well as better correlation when comparing participants' performance in the overall score against item-level performance. Psychometric evidence supports further instrument examination, which can improve this tool to measure gains in pharmacists' knowledge related to the care of transgender patients.

The Pharmacist as an LGBTQ Ally

An ally is defined as one who is associated with another as a helper that provides support and assistance in an ongoing struggle or effort. Pharmacists should be allies to their patients by ensuring optimal health outcomes and by helping their patients achieve therapeutic objectives and goals. However, most colleges of pharmacy are currently not well equipped to train future pharmacists to counsel lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) patients. This commentary explores reasons for discrepancies in health care access for LGBTQ patients and how efforts can be advanced to meet the needs of this minority group. Pharmacists require adequate training to provide optimal care for a more diverse patient population and to be both an ally in health and a reassuring supporter for members of the LGBTQ community.

Paediatricians' attitudes and beliefs towards transgender people: a cross-sectional survey in Israel

OBJECTIVE

The number of transgender and gender non-conforming children is on the rise. For these children, the timing of medical intervention is crucial, yet transgender children report poorer overall physical and mental health outcomes compared with their cisgender peers. We aim to describe how paediatricians perceive transgender people.

SETTING

The 'Transgender Attitudes and Beliefs Scale', which consists of 29 items in three domains-human value, interpersonal comfort and sex/gender beliefs-was administered to 391 senior and resident paediatricians in Israel. The responses on a 7-point Likert scale were collapsed into two categories: a mean score of ≥6 for each domain was a 'Favourable' perception and <6 'Unfavourable'.

RESULTS

Of 355 respondents (91% response rate), 221 (62%) were females, 132 (37%) were males and 2 identified as 'other'; 290 (82%) were born in 'trans-respect countries', 274 (77%) identified as secular, 223 (63%) were senior physicians and 132 (27%) were residents. Overall, 90% of the cohort scored favourably on the 'Human value' domain, 68% on 'Interpersonal comfort' and 40% on 'Sex/gender beliefs'. In the 'Interpersonal comfort' domain, being a man, birthplace in a transphobic country, identification as religious and being a senior physician were all associated with increased ORs for an unfavourable score: 2.1 (95% CI 1.3 to 3.4), 3.4 (95% CI 1.9 to 6.3), 2.4 (95% CI 1.4 to 4.2) and 1.8 (95% CI 1.1 to 3.0), respectively. In the 'Sex/gender beliefs' domain, being a man and identifying as religious had significantly increased ORs for unfavourable scores: 2.2 (95% CI 1.3 to 3.5) and 10.6 (95% CI 4.7 to 24.1), respectively.

CONCLUSIONS

Negative attitudes towards transgender people are still widespread among paediatricians. Interventions are warranted to positively impact these attitudes.