285 - Exploring Perceived Facilitators and Barriers to using Telemedicine for Gender-Affirming Care in Youth: A Qualitative Study

Poster Number: 285
Publication Number: 285.346

David J. Inwards-Breland, Rady Children's Hosptial/UCSD, San Diego, CA, United States; Debra Yeh, UC San Diego / Rady Children's, San Diego, CA, United States; Tay L. Richardson, UC San Diego School of Medicine, San Diego, CA, United States; Bixby Marino-Kibbee, Rady Children's Hospital San Diego, Encinitas, CA, United States; Maja Marinkovic, University of California, San Diego School of Medicine, San Diego, CA, United States; Kay Rhee, University of California, San Diego School of Medicine, San Diego, CA, United States

Background: Multi-disciplinary gender-affirming care centers (GACC) are seeing increasing numbers of transgender and non-binary (TNB) youth seeking medical care. In the wake of the COVID pandemic, telemedicine use in clinical settings, including GACC, have increased. There is a paucity of research in the provision of care by telemedicine for gender care as well as TNB youth’s perspectives on its use.

Objective: To explore perspectives of TNB youth in the use of telemedicine for gender-affirming care.

Design/Methods: Participants aged 13-21 years, who identified as TNB, were recruited from the Center for Gender Affirming Care at a large academic center to participate in a semi-structured interview and demographics survey. Interviews were audio-recorded and transcribed verbatim. Survey results were analyzed using descriptive statistics. Two independent coders reviewed the transcripts, developed a preliminary coding scheme, and reached consensus on discrepancies. ATLAS.ti® was used for thematic analysis.

Results: TNB youth (n=30) had a mean age of 17 years; 30% identified as female/trans female, 47% as male/trans male, and 23% as non-binary or gender fluid. Overall, participants favored in-person visits over telemedicine because of connection with their provider. Patients also had a lack of perceived knowledge about telemedicine despite having good working knowledge of technology. They had mixed feelings regarding clinic staff’s role in telemedicine (some felt it was a waste of time, others found it helpful to orient and offer future visits). There were minimal concerns around confidentiality and having a secure line. Advantages to telemedicine included convenience (no travel time or missing school), and discussion of hormone therapy, medication changes, and lab results. However, it was not optimal for full assessment of treatment progress because there was no physical exam. Conclusion(s): Despite participants’ preference for in-person visits, telemedicine is a viable option for TNB youth in receiving gender-affirming medical care because of convenience and perceived confidentiality. Efforts to increase telemedicine use could center on providers and clinic staff providing education on the technical aspects of telemedicine use and promoting its availability for discussion-based visits.  
Table 1: Participant Demographics
Table 2: Illustrative Quotes Regarding Facilitator and Barriers to Telemedicine use for Gender Affirming CarePage 1