CPhT CONNECT™ Magazine - Jan/Feb 2021


LGBTQ AND PHARMACY We live in an increasingly multicultural society with people from different ethnicities and beliefs. Over the years we have seen an ever-growing group of people who identify as having diverse sexual orientations and gender identities. For example, one such group is the LBGTQ (lesbian, gay, bisexual, transgender, queer) community. Many members LGBTQ community report having experienced negative interactions by the health care industry. In the past, the connection between homosexuality and psychopathology was largely based on religious, legal and medical stigmas. Perhaps the literature was limiting, perhaps mem- bers of this community were shunned or perhaps this population resisted seeking medical help for fear of the stigmas. No matter the reason, times have changed, the public has become more under- standing and the need is there for pharmacy staff to obtain more information regarding the needs of LGBTQ members and their concerns so that they may receive optimum care without historical fears. There have been many studies have shown that many LGBTQ patients experience more diffi - culty obtaining care which leads to healthcare disparities and unnecessary barriers to care. For this population, many find it difficult due to the stigma associated with LGBTQ and many in the healthcare industry may not even realize their specific challenges to emotional and physical needs. It is important that people take the time to understand what is important for this group of patients and in turn realize how to help them feel more welcome during pharmacy transac- tions. Much like many people throughout the U.S.A., informal surveys support that LGBTQ patients are more comfortable approaching their pharmacists, a profession often rated as one of trust. When these patients do not feel welcomed, included or experience a negative encounter at a pharmacy, they are less likely to return, which may have impact on their future health needs. They may also tell others about their experiences which could reaffirm any belief that they would not expect to receive fair and equal treatment. To better understand the needs of this popu- lation it is important to learn about the things that make it more comfortable and inviting to receive care. Anything from the language or terminology used to specific environmental fac - tors that may not be of major concern to others. Even though there are terms to describe how one views themself, just as many people are not certain how many terms are used or how they differ from one another. Here is some basic information that may help: Sexual orientation is a person’s emotional, roman- tic, sexual attraction, or non-attraction to other people and is composed of three separate dimen- sions: behavior, identity, and desire. Sex refers to a set of biological attributes primarily related to phys- ical and physiological features. The phrase “sex assigned at birth” (SAAB) or “designated sex at birth” (DSAB) is used to describe a person’s biologi - cal sex, most often, but not exclusively, based on the external appearance of genitalia at birth. Gender identity is a person’s inner sense of their gender. For some people, their gender identity may not be congruent with the one typically expected based on

their SAAB/DSAB. They may describe themselves in a variety of ways including, but not limited to, transgender, male, female, gender fluid/gender - queer, nonbinary, agender, or as another gender. Decisions to change gender expression and/or physical appearance to be more consistent with their gender identity through medical (e.g., hor- mone replacement therapy), nonmedical (e.g., voice therapy, choosing an affirming name, etc.), and/or surgical options (e.g. gender affirmation/confirma - tion surgery) is solely determined by the individual. In order to better serve these patients, pharmacies can take positive steps by examining their patient interactions, pharmacy environments, and policies and staff training to help pharmacy staff provide an inclusive and welcoming environment. Let us take a look at some things that may help you better understand the needs of the LGBQT patient. Language Matters: Being mindful and choos- ing your words carefully are the simplest ways to create a safe space for LGBTQ patients. It is not unusual for many to have documents (i.e., license, insurance cards etc.) that do not accu- rately reflect their authentic gender identity or chosen name. Pharmacy technicians can avoid confusion and prevent mistakes by asking patients “What name and pronouns do you use?” . This may also be documented in patient profiles so that all can be aware of what the patient would like to be called when they do business with your pharmacy. Use gender-neutral pronouns such as they/them when documenting or dis- cussing relevant patient information. Replacing expressions that assume a person’s or a group of people’s gender identity such as “Hello, sir/ma’am” or “Hello, ladies/guys” with a more generalizable option such as “Hello, how may I help you today?” reflects an inclusive and culturally sensitive approach. Pharmacy Environment: LGBQT patients report that they will observe a pharmacy area for things that they feel show they are accepted. Such things as marketing/health brochures which include same-sex couples or families or displaying health education materials from local LGBQT organizations allow for an inviting environment. Restrooms: Clear signage goes a long way. Some LBGTQ members seek restrooms that match their gender identity. Many busi- nesses have designed restrooms that provide single occupancy or gender-neutral restrooms. Staff Training: Training on LGBTQ identities, terminology and health disparities, as well as on how to avoid stereotypes and assumptions about patients’ sexual orientations and gender identities help to facilitate respectful communication with LGBTQ patients. Free online training is available from the National LGBT Health Education Center. In addition to the above LBGQT patients often have many questions regarding medications and in relation to their lifestyle. For example, hormone therapy or mental health medications. Following are some medical/treatment concerns of the LGBQT patient you may need to be aware of: HIV Prevention and Care: Pharmacies can help by being familiar with and referring to community

HIV testing sites. Keep a list of resources in your pharmacy to assist LGBQT patients who may have had difficulty finding them on their own. According to the Centers for Disease Control and Prevention (CDC), 1.2 Million Americans are likely candidates for PrEP (Pre-Exposure Prophylaxis). When taken as prescribed, PrEP has been shown to be safe and highly effective at reducing the likelihood of HIV acquisition. Work with patients on PrEP to pro- mote medication adherence and assist patients on PrEP in accessing payment assistance programs. Transgender Healthcare: Some trans- gender patients are on hormone therapy and sometimes insurance will deny medication because a drug therapy has been prescribed in a way that is not currently FDA-approved or not typi- cally addressed. Remain aware that often these patients are already leery of being treated differ - ently than others and are gauging your sensitivity to their needs. Explain the issue with the insur- ance, explain to the patient the issue itself and work towards processing to the best of your ability. Sexual Health: Studies including LGBT patients have shown they tend to be at higher risk for sex- ually transmitted infection and are may choose not receive preventive care out of fear. In addi- tion, statistics show that LGBQT people are more likely to be affected by sexual violence including rape, physical violence, or stalking from an inti- mate partner. Patients may ask their pharmacists to discuss concerns about sexual health. If a patient requests to speak to a pharmacist, be discreet as others nearby can often overhear. Remember pri - vacy and confidentiality concerns and your actions will show the patient if you are sensitive to their needs making them comfortable with discuss- ing their healthcare needs with the pharmacist. Mental Health: Some mental health disorders and conditions such depression, anxiety, psycho- logical distress, and PTSD are more prevalent in LGBTQ groups compared to the general popula- tion. These patients may experience higher rates of suicide as well. Limited data suggests transgen- der youth have a higher lifetime risk of substance abuse such as cocaine/methamphetamine. Eating disorders and unhealthy weight-control behav- iors occur more frequently among LGB youth and adults than their heterosexual peers. A vari- ety of professional organizations have already established guidelines to serve as resources for practicing professionals. A 2014 Field Guide pub- lished by the Joint Commission (https://www. jointcommission.org/lgbt/) assembled a series of health-system strategies, practice examples, and resources for patient-centered LGBT community. There are also pharmacy-specific reference mate - rials available for practicing pharmacists who seek continued education in this area. One such publication from the Human Rights Campaign (www.hrc.org) provides recommendations for establishing an inclusive environment within a pharmacy setting. The LGBT Health Education Center (www.lgbthealtheducation.org) at the Fenway Institute, in conjunction with the Institute of Medicine (IOM), provides comprehensive online resources for providers and patients alike.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663655/ https://www.pharmacytoday.org/article/S1042-0991(20)30876-8/fulltext

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