Access to care

Many lesbian, gay, bisexual, and transgender (LGBT) patients may avoid or delay accessing healthcare. The barriers to care are multifactorial and occur on a systems level as well as in the exam room between the provider and patient. In this chapter, we describe the evidence behind barriers to care and argue that establishing a medical home for LGBT patients is an essential step to closing the healthcare gap. GLMA: Health Professionals Advancing LGBT Equality, a health advocacy organization, suggests a number of strategies employed by practices successful at providing LGBT patients with competent care in a patient-centered environment. We describe these strategies as a way to establish a patient-centered medical home or patient-centered practice to facilitate access for LGBT patients. One of the challenges for the PCP attempting to be welcoming to LGBT patients is that of identifying who they are. We provide specific language and questions that can be applied in a culturally sensitive and accurate method to assess sexual orientation and gender identity of patients as appropriate to the clinical context.