Abstract
IntroductionExpanding on data concerning emergency department (ED) use and avoidance by the sexual minority (those who identify as lesbian, gay, bisexual, queer, other [LGTBQ+]) and gender minority (those who identify as transgender, gender nonconforming, other) community may inform future ED LGTBQ+ training and clinical practice. Investigation objectives included characterizing rates of emergency care avoidance, identifying barriers to emergency care, and assessing emergency care quality and cultural competency for sexual and gender minorities.MethodsIn this population-based, cross-sectional needs assessment, sexual minority, gender minority, and/or cisgender heterosexual-identified participants were selected based on participants’ subscription to newsletters or social media accounts for One Colorado, an LGBTQ+ advocacy organization. Each participant completed a single digital survey that collected qualitative and quantitative data about ED perception, use, and demographics.ResultsA total of 477 LGBTQ+ or heterosexual-identified individuals (mean age = 44.3 (standard deviation [SD] = 16.7)) participated in the study. Lifetime emergency care avoidance rates for gender minorities were markedly increased (odds ratio [OR] 3.8, 95% confidence interval [CI], 2.2 – 6.6; P <.001), while avoidance rates for sexual minorities were similar to those of cisgender heterosexual respondents (17% vs 14%; P <.001). Gender minorities were more likely than sexual minorities to both avoid emergency care due to fear of discrimination (43% vs 15%; P =.002) and to have experienced discrimination during their last ED visit (OR 11, [95% CI, 5–24]; P <.001). No significant differences were observed between participants in care avoidance due to financial reasons or prior negative experiences. No cited ED factors that influenced identity disclosure decisions were distinctly predictive.ConclusionGender minorities are more likely than sexual minorities and heterosexual cisgender individuals to report ED avoidance and discrimination at last ED visit. Future work characterizing deficits in LGBTQ+ ED care might reduce these avoidance and discrimination rates, enhancing the level of patient care provided to this population.
Highlights
Expanding on data concerning emergency department (ED) use and avoidance by the sexual minority and gender minority community may inform future ED LGTBQ+ training and clinical practice
Gender minorities were more likely than sexual minorities to both avoid emergency care due to fear of discrimination (43% vs 15%; P =.002) and to have experienced discrimination during their last ED visit
Gender minorities are more likely than sexual minorities and heterosexual cisgender individuals to report ED avoidance and discrimination at last ED visit
Summary
Expanding on data concerning emergency department (ED) use and avoidance by the sexual minority (those who identify as lesbian, gay, bisexual, queer, other [LGTBQ+]) and gender minority (those who identify as transgender, gender nonconforming, other) community may inform future ED LGTBQ+ training and clinical practice. 78% of LGB individuals surveyed had a primary care doctor with whom they were comfortable discussing LGB issues.[3] a Canadian study found 21% of transgender respondents reported previously avoiding emergency care due to fear that their identity would affect their care.[4] A subsequent study supported the Canadian investigation, finding gender minority-identified participants more likely to report negative effects of identity disclosure to their provider.[5] Despite these foundational investigations, no prior study has provided detailed data on care avoidance for both sexual and gender minorities, care satisfaction, and factors associated with identity disclosure in the emergency care setting
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