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Harvey J. Makadon, MD, is in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and a Professor of Medicine at Harvard Medical School. He was the former Director of the National LGBT Health Education Center at the Fenway Institute. He teaches about how to improve access to quality care for lesbian, gay, bisexual, and transgender people in health care settings around the country. He has a particular interest in working with both consumers and providers to achieve patient centered environments for prevention and care, and working with providers to transform practices to be more welcoming and inclusive of all.
Dr. Makadon is the lead editor of The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, published by the American College of Physicians. A second edition was published in 2015. In addition to writing numerous articles and chapters related to LGBT health, he served on the Advisory Committee to the Institute of Medicine of the U.S. National Academy of Sciences in the preparation of The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding published in March, 2011.
Presentation: Transforming Health Care to be Inclusive and Affirming of LGBTQ People and to Overcome Health Disparities They Experience
Time: Break Session 1
The roots of practice transformation apply to the care of all patients with a focus that builds care and care systems around the needs of patients and clients, often referred to as patient-centered care. Beyond that there are specific issues to be considered to accomplish goals regarding the care of specific populations and insuring that they are receiving equitable quality care that eliminates population based health disparities. This workshop will review basic principles of practice transformation, LGBTQ specific health disparities and steps that need to be taken to ensure that all receive access to high quality equitable care. Issues affecting both organizational structures, systems, and interpersonal communications will be described beginning with involvement of both leadership and staff, looking at how to collect data to learn their needs, describing examples of how to communicate affirmatively with patients regarding issues of their care, detailing examples of specific systems and clinical efforts to provide inclusive care, and how to both learn from the community and incorporate changes in the care environment that communicate that this is a welcoming and inclusive practice.
There will be more focused discussion on both collection of SO/GI data in clinical settings, as well as what kind of systems build into EHR’s to improve care for patients. Decision support built into EHR’s is commonly used to help guide clinicians do the right thing based on the demographics of someone they are seeing. It must be built to incorporate the needs of LGBTQ people. For example, one needs to know that is someone is transgender what preventive care they require for general health, as well as cancer prevention. Examples are the need for prostate screening in transgender women and breast screening in all transgender people. For someone at high risk of HIV, it will be important that there is guidance on how to suggest high impact HIV prevention and to whom. In addition, there will be detailed discussion of the important of education all staff, including front line staff, on the basics of affirmative communications with LGBTQ individuals coming for care or receiving care. Effective communications throughout a care organization can have a large impact on linkage and engagement in care.
1. Describe health disparities and inequities that affect LGBTQ people across the life cycle.
2. Discuss how stigma and discrimination can present barriers to access and engagement in care.
3. Describe steps to transforming health care to overcome health disparities and provide equitable quality care for all including LGBTQ people.
4. Be prepared to discuss ways that individuals can work to make a practice more affirming and keep people engaged in care with respect to specific health disparities (e.g. HIV prevention, gender affirmation).