62. The Impact of Telemedicine on Access to Gender-Affirming Care for Rural Transgender and Gender Diverse Youth

ABSTRACT

Purpose: Transgender and gender-diverse (TGD) youth are highly susceptible to negative health sequelae including high rates of depression, suicidal ideation, self-harm, and suicide attempts. Rural TGD youth have the added difficulties of living amid people who may hold more negative views toward gender diversity, and a dearth of TGD care, leaving them with far less support than their urban counterparts. The rapid expansion of telemedicine during the initial months of the coronavirus pandemic of 2019 enhanced access to many populations but it is not clear how this has impacted access for rural TGD youth, particularly those living in areas with limited broadband access. As such, the purpose of this research was to explore access to care for TGD youth by determining how telemedicine impacts appointment attendance for rural TGD youth. Methods: We used a retrospective quantitative design and an encounter-level dataset to evaluate the study purpose. We extracted a secondary data set from the electronic medical record (EMR) of an adolescent and young adult (AYA) clinic that provides gender-affirming (GA) care. The clinic is the only one of its kind in the state, and serves both rural and urban populations. In addition to EMR data, address data was used to develop rurality and distance to care variables. All visits to the clinic from March 2020 through December 2021 were included in the data. Descriptive statistics and bivariate analyses were conducted to characterize the population and multivariate analysis were used to model the association between visit attendance and covariates of interest. Specifically, logistic regression with GEE was implemented to account for repeated measurements and within-patient correlation. Results: Nearly 3000 unique patients were identified from over 18,000 visits during the study period, with 984 visits (5.5%) identified as related to GA care;386 (39.2%) of these visits were by patients from rural areas. During the study period 4917 (27.4%) of all encounters were scheduled for telehealth compared with 149 (15.1%) of GH visits. Although the overall no-show rate for the clinic was 10.9%, the rate for GA visits was significantly lower (6.5%;p<.001) and the rate for GA visits for patients from rural counties was even lower (5.7%, compared with 8.93% for non-GA rural visits). The NS rate for GA telemedicine visits was 0.0%. In multivariable analysis, GA visits were associated with a 42% reduction in odds of NS after adjusting for rurality, telemedicine visit, age (over 18 vs. under 18), travel time, and patient's gender identity. Conclusions: AYA from rural areas who are seeking GA care are less likely to no-show for clinic and telemedicine visits than patients seeking other types of care and from non-rural areas, suggesting that this care is highly valuable to patients. Our results indicate that ensuring a reliable telemedicine connection for rural AYA is an important component of providing access to GA care. Sources of Support This project was supported by a grant from the Daisy Foundation.