Data on sexual orientation and gender identity is critical to closing care disparities across the LGBTQ population, but patients aren’t always comfortable sharing their SOGI details with their health care providers for a variety of reasons, including fear of discrimination.
According to a 2024 KFF report, LGBTQ adults are twice as likely as non-LGBTQ adults to report a negative experience while receiving health care in the past three years.
The CARE Center at Dignity Health St. Mary Medical Center in Long Beach, California, a specialty clinic that primarily serves LGBTQ patients, has seen this firsthand.
“85 percent of our patients are LGBTQ,” said Paul LaBrie, executive director of the CARE Center, “and many of them face a variety of challenges and barriers from providers and staff who don’t understand or respond to their needs.”
To ease patients’ anxieties about disclosing personal information such as SOGI and sexual health habits, the CARE Center has introduced digital tools that allow patients to self-report data.
Efficient data collection
Using tools from health IT vendor Phreesia, the clinic sends patients a link to a pre-visit survey, which they can then complete digitally on their smartphones before their next appointment after answering a few security questions.
If patients don’t have a smartphone, reception staff can provide them with a tablet to complete the survey when they arrive at the clinic.
Labrie said adoption of digital tools is high, with about three-quarters of the clinic’s patients regularly self-reporting their data.
In addition to giving patients a way to share sensitive information privately, self-reported data can help ensure healthcare providers are addressing all of their patients’ needs.
For example, screening for anxiety and depression is important to alert LGBTQ patients to mental health concerns. Census Bureau data shows that LGBTQ people face more mental health issues than non-LGBTQ people, highlighting the need for regular mental health evaluations.
In addition to giving patients a way to share sensitive information privately, self-reported data can help ensure healthcare providers are addressing all of their patients’ needs.
However, when a patient does not exhibit outward symptoms of depression, health care providers may forget to examine the patient’s mental status during the consultation, especially if the patient is dealing with other health concerns.
The CARE Center uses digital tools to send patients screens for anxiety and depression every three months, and the self-reported data is integrated with the clinic’s EHR for easy access during patient visits.
LaBrie noted that by having patients undergo a mental health screening before their appointment, it’s one less thing medical professionals have to remember during the patient visit.
In addition to flagging concerns about anxiety and depression, the questionnaire can also help prompt conversations about the social determinants of health, he added.
For example, if a patient discloses to a provider that they are experiencing anxiety due to housing or food insecurity, the doctor can refer the patient to an on-site social welfare counselor who can help them access social services.
“Surveys can generate a lot of conversation and help address these issues,” LaBrie emphasized.
Since implementing the tool, the CARE Center has digitally collected more than 11,500 patient-reported outcomes.
Appointment Reminders
In addition to self-reported data, the technology will enable clinics to send appointment reminder text messages and calls.
Labrie noted that patient retention is important for all patient populations, but is especially important given the public health aspects of caring for the LGBTQ patient population.
“We want HIV-positive people to get on medication as soon as possible so they can get their viral load down to undetectable levels, stay healthy and prevent them from transmitting HIV to others,” Labrie said.
Patient retention is also important to ensure adherence among individuals receiving PrEP services, as PrEP is significantly less effective when taken irregularly.
“You can set specific appointment reminder text messages or phone calls depending on the type of visit,” LaBrie says.
For example, the clinic offers long-acting injectable medications for HIV-positive and PrEP patients. These medications are a convenient treatment option because patients only need to take the injectable medication once every two months.
However, to ensure adequate levels of the drug in the body for effective HIV treatment and prevention, patients should receive their next dose within five to seven days after the two-month mark.
“Appointment reminders and being able to customize them for each patient group is really important,” Labrie emphasized.
Health IT also allows the clinic to send a check-in text three days after a patient starts taking a new medication.
“Patients, especially those new to the clinic, may be hesitant to talk to us about side effects they’re having,” Labrie says, “and we want to make sure they’re able to let us know about anything, like if they have an issue with their pharmacy or a prior authorization.”
Implementing follow-up texts will enable clinics to quickly address any issues that arise and ensure patients stay on track with their treatment plans and feel supported throughout their healthcare journey.
“We take great pride in providing the highest quality care, so we need every tool we can to ensure we provide that to our patients,” Labrie said.
Hannah Nelson has been covering health information technology and health data interoperability news since 2020.
