Increasing Access to Care for Transgender/Gender Diverse Youth Using Telehealth: A Quality Improvement Project

Purpose: We sought to expand telehealth at an academic multidisciplinary pediatric gender center to increase access to gender-affirming care without compromising communication, privacy, or patient satisfaction. Materials and Methods: Patient needs assessments were performed from January 2019 to March 2020. The severe acute respiratory syndrome coronavirus 2 pandemic accelerated implementation of the quality improvement project, and clinically appropriate patients were scheduled for video visits starting March 16, 2020. From September 8, 2020 to October 2, 2020, caregivers of transgender and gender diverse (TGD) minors or TGD young adults pursuing gender-affirming medications completed 9-item surveys evaluating communication quality and privacy, access to care, and quality of services for video and clinic visits. Answers were rated via Likert scales (1 = strongly agree, 5 = strongly disagree; 1 = less travel time, 4 = more travel time). Results: Needs assessment (n = 69) showed that 63.8% felt that video visits would improve follow-up. Survey participants (n = 91) reported statistically significant differences (p < 0.05) in several areas. Compared with clinic visits, video visits were more convenient, 1.21 +/- 0.435 versus 2.36 +/- 1.207, took less time from other activities, 4.55 +/- 0.522 versus 2.93 +/- 1.281, required less travel time, 1.03 +/- 0.180 versus 2.63 +/- 0.901, and were more acceptable, 1.35 +/- 0.545 versus 1.65 +/- 0.736. Participants were more likely to choose video visits in the future, 1.32 +/- 0.555 versus 1.57 +/- 0.732. There were no statistically significant differences in communication quality, privacy, or overall satisfaction. Conclusion: An integrated clinic-video visit model increases access to gender-affirming care for TGD youth while maintaining excellent communication, privacy, and patient satisfaction.