Impact of Telemedicine on Access to Care for Rural Transgender and Gender-Diverse Youth

Abstract

To explore the impact of telemedicine on access to gender-affirming care for rural transgender and gender diverse youth. A retrospective analysis of data drawn from the electronic medical records of a clinic that provides approximately 10,000 adolescent and young adult visits per year and serves patients seeking gender health care. The no-show rate was examined as a proxy for access to care due to anticipated challenges with recruiting a representative sample of a historically marginalized population. Logistic regression with generalized estimating equations was conducted to model the association between the odds of a no-show visit and covariates of interest. Telemedicine visits, rural home address, gender health visits, longer travel time, and being under 18 years old were associated with lower odds of a no-show in univariate models (n=17928 visits). In the adjusted model, the odds ratio of no-shows for gender health visits was 0.56 (95% CI 0.42 - 0.74), adjusting for rurality, telemedicine, age (under or over 18), and travel time to the clinic. In this study, telemedicine was associated with reduced no-shows overall, and especially for rural, transgender and gender diverse youth, and patients who hold both identities. While the no-show rate does not fully capture barriers to access, these findings provide insight into how this vulnerable population may benefit from expanded access to telemedicine for rural individuals whose communities may lack providers with the skills to serve this population.