Improving the integration of care for trans adults: ICTA a mixed-methods study

Abstract

Background: This research concerns improving the National Health Service health services trans adults need. These include the national specialist Gender Identity Clinics that support people making a medical transition. Not all trans people need to make a medical transition, and transition can take many different paths. Waits to be seen by Gender Identity Clinics are, however, several years long, and there may be significant problems of co-ordination between different aspects of transition-related care, and between transition-related care and general health care. Objectives: The main objectives were to understand which factors make services more or less accessible and acceptable to the variety of trans adults and how initiatives for providing more person-centred and integrated care can be successfully implemented and further improved. Design, data sources and participants: An online and paper screening survey was used to gather data on demographics and service use of trans people across the United Kingdom, with 2056 responses. Researchers used survey data to construct five purposive subsamples for individual qualitative interviews, identifying groups of people more likely to experience social exclusion or stigma. There were 65 online interviews. In addition, 23 trans Black people and people of colour attended focus groups. Results: The following undermine person-centred co-ordinated care and can lead to experiences of harm: • lack of respectful treatment of trans people by general practitioner practices; • inadequate funding of services; • lack of support during waiting; • the extended and challenging nature of Gender Identity Clinic diagnostic assessments, sometimes experienced as adversarial; • breakdowns in collaboration between Gender Identity Clinics and general practitioner practices over hormone therapy; • lack of National Health Service psychological support for trans people.