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.

Quality of life and level of satisfaction with pharmacotherapeutic follow-up in a transgender health center in Brazil

Trans people face numerous barriers to access and permanence in health services, which makes it difficult, among other things, to know about their quality of life and satisfaction with health services related to these users. Thus, the objective was to describle the quality of life and satisfaction with pharmacotherapeutic follow-up in transgender people. A cross-sectional, descriptive, and quantitative study was conducted between January and September 2022 at a specialized outpatient clinic for transgender individuals. The following aspects were describle: sociodemographic and medication profiles; quality of Life, which was measured using the WHOQOL-BREF questionnaire; and levels of satisfaction with Pharmacotherapeutic Monitoring, assessed through the Pharmacy Services Satisfaction Questionnaire (QSSF). Descriptive analyses employed measures of central tendency, absolute and relative frequencies, while inferential analyses used the Student's t test. A total of 101 transgender individuals participated in the study, with a mean age of 25 years, the majority being single (79.2%/80), having more than 11 years of education (47.5%/n = 48), and comprising 48.5% (n = 49) transgender women. Hormone use was reported by 59.4% (n = 60) of the participants, with 18.3% (n = 11) of self-medication. Testosterone cypionate was the most common hormone used by transgender men (84%), while cyproterone acetate and estradiol represented 60.4% of hormone use among transgender women. Additionally, 36 transgender individuals were taking other drugs (n = 60), mainly antidepressives (28%). The WHOQOL-BREF showed higher scores in the domains of self-rated Quality of Life, and physical, and psychological well-being among transgender women compared to transgender men, but without statistical differences. Income revealed a statistically significant association with psychological domains and overall quality of life. The results of the QSSF indicated that the overall mean and average scores per question were higher than 4, suggesting that 100% of the sample was satisfied with the provided service. No statistically significant differences were observed in the Quality of Life between transgender men and women, but income was associated with the psychological domain and overall Quality of Life. All participants reported satisfaction with the Pharmacotherapeutic Monitoring service; however, there is a need to expand service offerings, such as medication dispensing.

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.

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.

Teaching transgender patient care to student pharmacists

INTRODUCTION

This study describes content on transgender care taught in a doctor of pharmacy (PharmD) course and evaluates students' confidence and knowledge of providing care for transgender people. It also examines what pharmacy students want to learn about providing care to transgender people.

METHODS

Three hours of transgender patient care content was integrated into a pharmacy course that focused on therapeutics of special populations. Students completed an electronic survey before and after the class sessions to identify changes in their confidence in caring for transgender patients. The pre-class survey inquired about what the students were hoping to learn. The post-class survey asked students what was missing from this session that they would have liked to learn. Knowledge regarding transgender care was assessed through a multiple-choice examination.

RESULTS

Students reported interest in improving communication skills, learning terminology/vocabulary preferred by transgender people, and understanding population-specific challenges faced by transgender patients. Students reported they would have liked additional information about the transition, being transgender, and local resources available. Student confidence in asking about patient pronouns and counseling on effects of medications for gender transition were both significantly increased from the pre-class survey to post-class survey. Students demonstrated proficiency toward the learning objectives, with a 92.4% average on the examination questions on transgender care.

CONCLUSIONS

Student pharmacists are interested in learning skills to provide care to transgender patients. A learning session on transgender patient care integrated into a PharmD curriculum increased student knowledge and confidence in caring for transgender patients.

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.

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.

Student pharmacists' perceptions of transgender health management

INTRODUCTION

To measure the general perceptions and attitudes of pharmacy students toward transgender patients and health and evaluate students' level of support for receiving education in transgender healthcare.

METHODS

This study was a cross-sectional survey delivered online to approximately 60 s-year pharmacy students enrolled in a required pharmacotherapy course at the University of Maryland School of Pharmacy. Students received a survey link, with five questions for completion prior to the "Gender Transition Therapeutics" lecture and a separate link with 11 questions for completion post-lecture. Responses were anonymous with no identifiers collected and multiple-choice, using Likert-scale questions aimed at gathering respondents' perceptions of managing transgender patients and support for receiving additional education in transgender healthcare.

RESULTS

Survey results indicated that students' cultural competency and confidence in managing transgender patients increased after lecture, and that they support integrating transgender health into pharmacy education. Significant findings include: 67% of students lacked confidence in their ability to treat transgender patients prior to the lecture while only 20% of students reported this lack after the lecture. 51% of students reported being aware of barriers-to-care experienced by the transgender population compared to 92% of students after the lecture. After the lecture, 87% agree pharmacists need more education in transgender health, and 74% support integrating this education into pharmacy curricula.

CONCLUSIONS

Students' confidence in managing transgender health increases after didactic education, and overall, students support integrating transgender health education into pharmacy school curricula.

Incorporating LGBTQ health into the curriculum: Assessment of student pharmacists' knowledge and comfort level in caring for transgender patients

BACKGROUND AND PURPOSE

This study aimed to measure the effects of instruction regarding transgender health in second-year student pharmacists and provide qualitative insight regarding their impressions of the educational experience.

EDUCATIONAL ACTIVITY AND SETTING

Students completed a pre- and post-survey assessing knowledge regarding transgender therapeutics, the pharmacist's role, level of comfort providing care, and impression of exposure to the topic. McNemar's test and paired t-tests compared respondent data before and after the activity. The post-survey evaluated the learning activity, with an opportunity to leave open comments that were then analyzed using content analysis.

FINDINGS

Eighty-five of 107 (79.4%) students completed both surveys and were included in the analysis. Transgender therapeutics knowledge, participant understanding of pharmacist's role, comfort level, and assessment of adequateness of exposure improved significantly (p < 0.001). A majority (82.4%) affirmed that more than one exposure to issues regarding care of transgender patients is needed in the curriculum. Fifty-five open comments offered by 23 students were coded and categorized into two overall themes with four and two subthemes, respectively. Strengths of the activity were topic importance, exposure appreciation, presentation style, and knowledge foundation. Opportunities for improvement included providing more information and different types of information.

SUMMARY

The activity increased student pharmacists' knowledge regarding transgender therapeutics, the pharmacist's role, and comfort level in caring for this patient population. Respondents found the content valuable and desired more. Colleges of pharmacy should consider increasing exposure to specific patient populations, such as transgender patients, to prepare students for practice.

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

OBJECTIVES

The objectives of this study were (1) to assess pharmacist readiness to provide pharmaceutical care for transgender patients through measuring both pharmacists' knowledge and attitudes towards transgender patients, (2) to assess transgender patients' perception of pharmacist readiness to provide them pharmaceutical care through measuring both pharmacists' knowledge and attitudes toward them, and (3) to compare pharmacist readiness to provide pharmaceutical care for transgender patients and patient perception of this readiness.

DESIGN

The study used a descriptive, cross-sectional design. The pharmacist's readiness and the transgender patient's perception of their readiness, defined as a combination of knowledge and attitude, were evaluated. Two separate, validated questionnaires with dichotomous, multiple choice, and open-ended questions were used to measure both constructs among both populations.

SETTING

Community-based research.

PARTICIPANTS

Pharmacists practicing in Puerto Rico were provided the questionnaire by e-mail or in person. Transgender participants in Puerto Rico were recruited through health clinics and community partners and were surveyed in person. The analysis included responses from 96 pharmacists and 31 transgender participants.

RESULTS

The majority of the pharmacists' knowledge scores (90%) were found in the low (0-5) and moderate (6-10) ranges, with a mean score of 7.23 out of a total possible score of 16 (SD ±2.36). For the attitude construct, most of the scores (81%) were found in the high (18-26) range, with a mean score of 19.63 out of a total possible score of 26 (SD ±3.65). For both constructs, transgender patient perceptions echoed the results of the pharmacists, indicating several perceived knowledge deficits in combination with mostly positive attitudes.

CONCLUSION

The majority of pharmacists demonstrated positive attitudes toward caring for transgender patients, and transgender patients also perceived these positive attitudes from pharmacists. However, the measured and perceived knowledge deficits observed in this study suggest the need for educational interventions to improve pharmacist readiness to provide care for transgender patients.

The Evolving Role of Pharmacists in Transgender Health Care

Pharmacists are increasingly part of a multifaceted team providing health care to members of the often marginalized transgender (TG) community. Some pharmacists, however, may feel unprepared to care for and interact with TG individuals. By providing comprehensive, respectful, and gender-affirming support, improving physical pharmacy environments with policies and procedures, pharmacists can be trustworthy providers for TG patients. This review focuses primarily on the health issues of TG persons and the pharmacist's role in promoting health, identifying barriers to health care, and providing health care resources for TG persons. The evolution of psychiatric diagnostic criteria, access to health care, and inclusion of TG, lesbian, gay, and bisexual topics in the educational curriculum are presented. Cultural competency and diversity training that addresses gender identity and sexual orientation issues should be important interdisciplinary and interprofessional activities for all health care professional education programs. Pharmacists play a key role in the health care needs of TG persons that include appropriate laboratory monitoring, complex pharmacotherapeutic challenges, and providing unbiased gender-affirming interactions. The pharmacy's physical environment, staff training, and policies and procedures can offer unique services to TG persons.

Illness Management in Older Lesbian, Gay, Bisexual, and Transgender Couples: A Review

More openly sexually and gender diverse people are aging into later life across the world as generational transitions occur. People identifying many different ways beyond cisgender and heterosexual are diverse with respect to many other characteristics and sociopolitical locations across the globe and may thus experience a wide array of health journeys both individually and as partners in intimate relationships. In this review article, we summarize the major contributions of and ongoing gaps in existing studies about such couples’ experiences of chronic disease management in later life. We focus on three key groups of findings from prior research about the health of older sexually and/or gender diverse couples: care practices, unmet needs, and diverse resources. We outline priorities for future research within and across these topic areas and in varied locations, with unique recommendations for scholars in both academic and clinical settings. These recommendations support greater integration of such populations, topics, and needs in existing discourse on aging and late life. Likewise, recommendations from this review illuminate potential best practices for engaging and serving these elders in both academic and applied settings.

Addition of Care for Transgender-Related Patient Care into Doctorate of Pharmacy Curriculum: Implementation and Preliminary Evaluation

The number of transgender and gender-diverse patients seeking medical care in the United States is increasing. For many of these patients, pharmacotherapy is a part of their gender-affirming transition. Effective instructional methods and resources for teaching pharmacy students about this patient population’s social considerations and medical treatments is lacking. Three hours of educational material on caring for transgender patients was added to a third-year course in a four-year Doctorate of Pharmacy program in the United States. The content included cultural, empathy, and medical considerations. Students in the course were given a survey to assess their perception of each instructional method’s effectiveness and self-assess their confidence in providing competent gender-affirming care to transgender people before and after the learning session. The survey response rate was 36% (54/152). Students’ self-assessed confidence to provide competent care to people who are transgender increased significantly. Before the learning session, the median confidence level was 4/10 (Interquartile range (IQR) 3–6), after the class session, the median confidence increased to 7/10 (IQR 6–8, p < 0.01). Students rated the pre-class video, jeopardy game, and patient panel as most helpful to improving their skills. The addition of transgender-related patient care material into the Doctorate of Pharmacy curriculum significantly increased the students’ confidence to provide competent care to people who are transgender.