Training pediatricians critical to improving quality of care for transgender youth

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Credit: Pediatric Academic Societies

TORONTO, May 5, 2018 – Two new studies reveal the importance of better understanding the health care utilization of transgender children and adolescents and the need to train pediatricians to care for this population's unique needs.

Nadia Dowshen, MD, MSHP, and Siobhan Gruschow, MPH, MEd, researchers at PolicyLab at Children's Hospital of Philadelphia, will present their findings on trends in transgender youth's health care utilization and primary care providers' knowledge, comfort and experience caring for transgender youth during the Pediatric Academic Societies (PAS) 2018 Meeting in Toronto.

The first study focused on measuring the knowledge, attitudes and skills of primary care providers in treating transgender children and adolescents. Researchers designed a cross-sectional survey aimed to learn more about the readiness of pediatricians to care for transgender or gender non-conforming youth.

"Pediatricians may be the first or only contact for many transgender youth in the health care system, and therefore it is essential that pediatric providers be knowledgable and comfortable in caring for this population of youth with unique health care needs," said Ms. Gruschow, lead author of the study. "The results of our research show that we critically need educational interventions to prepare pediatricians in supporting transgender youth's health, well-being and early development."

The research team recruited survey participants either via email or in-person based on where their health care practice was located. Participating primary care pediatricians responded to 18 questions related to their knowledge, experience and comfort in providing care for transgender youth.

They found that among the 161 participants, prior professional or personal experience with transgender youth was associated with an increased comfort in providing care for this population of children and adolescents. Researchers also discovered that primary care pediatricians have poor knowledge of existing guidelines for care including that only half were aware of when it is indicated to prescribe puberty blockers; however, respondents expressed high levels of interest in additional training.

In the second study, researchers identified prevalence and patterns of youth accessing care for gender dysphoria (GD) through a retrospective analysis of medical administration claims from Clinformatics Data Mart, a large database of privately insured enrollees. Analyzing inpatient and outpatient claims of 18.4 million transgender youth ages 5-21 between 2010-2014, the researchers discovered a significant increase in GD-related claims from 113 to 464 in children or adolescents. While the rate of claims in age groups did not vary, they saw a variation year by year in the geographic regions where claims were made.

"Our study revealed significant increases in the prevalence of insurance claims among children and adolescents related to GD across the U.S.," said Dr. Nadia Dowshen, lead author of the study. "More studies like ours are needed to describe health care utilization by transgender youth and to inform the development of policies to ensure that providers are adequately trained and equipped with the resources they need to meet these youth's physical and mental health needs."

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Ms. Gruschow will present "Pediatric Primary Care Provider Knowledge, Attitudes, and Skills in Caring for Transgender Youth" and Dr. Dowshen will present "Trends in Prevalence of Medical Claims Related to Gender Dysphoria Among Children and Adolescents in the US from 2010 to 2014" on Monday, May 7 at 10:30 a.m. EDT. Reporters interested in an interview with the authors should contact Lauren Walens at [email protected]

Please note: Only the abstracts are being presented at the meeting. In some cases, the researchers may have additional data to share with media.

The PAS 2018 Meeting, taking place in Toronto on May 5-8, 2018, brings together thousands of pediatric scientists and other health care providers to improve the health and well-being of children worldwide. For more information about the PAS 2018 Meeting, please visit http://www.pas-meeting.org.

About The Pediatric Academic Societies (PAS) Meeting

The Pediatric Academic Societies (PAS) Meeting brings together thousands of pediatricians and other health care providers united by a common mission: improve the health and well-being of children worldwide. This international gathering includes researchers, academics, as well as clinical care providers and community practitioners. Presentations cover issues of interest to generalists as well as topics critical to a wide array of specialty and sub-specialty areas. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting and #PAS2018, or like us on Facebook.

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Abstract: Pediatric primary care provider knowledge, attitudes, and skills in caring for transgender youth

Background: Transgender youth have specific healthcare needs. Pediatric primary care providers may be the first or only point of contact for these children in the healthcare system, and thus can play an essential role in their health and well-being.

Objective: The objective of this study is to better understand pediatric primary care providers' knowledge, attitudes, and skills in caring for transgender youth.

Design/Methods: Between January and May 2017, we conducted a cross-sectional survey of 460 pediatric primary care providers employed in two pediatric hospital care networks and in city health department clinics in a large metropolitan area. Participants from hospital network practices were recruited via email and those at city health centers were recruited in-person. Surveys were administered electronically or on paper and included 18 items about knowledge, experience, and comfort providing care for transgender youth. Data were analyzed using descriptive statistics and Pearson chi square for bivariate analyses.

Results: Of the 161 respondents (35 percent response rate), 134 (83 percent) were physicians and 11 percent were nurse practitioners and in practice for a mean of 18.6 years (sd: 10.9, range: 1-44). The majority of respondents were female (83 percent), and 80 percent were white, 7 percent Asian, and 5 percent African American. More than half (54 percent) of participants did not know there were professional guidelines to support puberty blocking medications for a child who identifies as transgender. Providers who reported having prior experience caring for LGBT youth reported feeling more comfortable knowing where to refer patients than providers with no experience (68.3 percent and 23.08 percent, respectively, p=0.002). Providers with personal experience with someone who identifies as transgender reported feeling more comfortable talking to patients about gender identity than those without personal experience (88.5 percent vs 48.8 percent, p=0.002). The majority of participants (86.3 percent) agreed they would be better clinicians if they had more training on supporting transgender youth.

Conclusion(s): Prior experience with transgender youth, whether personal or professional, was associated with increased comfort in providing care. There was also poor knowledge of existing guidelines and high levels of interest in additional training. Our findings suggest an urgent need for targeted educational interventions addressing the care of transgender youth for practicing pediatricians.

Authors: Siobhan Gruschow, Sara Kinsman, Natasha Graves, Nadia Dowshen

Abstract: Trends in prevalence of medical claims related to gender dysphoria among children and adolescents in the US from 2010 to 2014

Background: Transgender youth face numerous challenges to their physical and mental health and well-being, but little is known about the prevalence and patterns of youth accessing care for gender dysphoria (GD).

Objective: To identify trends in prevalence of children and adolescents with GD-related claims by age and geographic region.

Design/Methods: We conducted a retrospective analysis of medical administrative claims from Clinformatics Data Mart, a large database of privately insured enrollees in the US. Transgender youth aged 5 -21 were identified using claims from inpatient and outpatient services with International Classification of Diseases ninth edition (ICD-9) diagnosis codes related to GD between 2010 and 2014. Age was categorized as

Results: From 2010-2014, the number of children and adolescents with a GD-related claim increased from 113 to 464 and the total number of claims increased from 576 to 3,495. Age- and region-adjusted prevalence of GD increased steadily from a rate per 1000 persons of 0.024 (95 percent CI: (0.018, 0.032) in 2010 to 0.13 (95 percent CI: (0.11, 0.14) in 2014.The rate of diagnosed children and adolescents within each age group (

Conclusion(s): From 2010-2014 there was a significant increase in the prevalence of youth with GD-related claims and there was variation by geographic region. Identifying transgender children and adolescents in large administrative datasets and describing their care utilization will be critical to future health services research for this vulnerable and often invisible population of youth.

Authors: Nadia Dowshen, Siobhan Gruschow, Jennifer Faerber, Amy Hillier

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