SPOKANE, Wash.—Health care has seen an incredible amount of growth, innovation and evolution in recent years with the advancement of medical knowledge and integration of technology. This increased quality of care coupled with increased access to care through insurance exchanges has translated into a higher demand for health care services in a wide range of fields. However, much of the time this means patients are experiencing a growing problem: a lack of highly trained health care providers to deliver these specialized services.
One such area that has seen exponential growth in the demand for clinical services is within the population of transgender and gender-nonconforming (TGNC) people.
“Care for transgender and gender non-binary patients must be tailored to each individual focusing on their individual gender identity and goals for transition.” says Cheyenne Newsome, a clinical assistant professor at the Washington State University College of Pharmacy. “It is definitely not a one size fits all treatment.”
According to Newsome, there is a great mismatch between the growing number of patients seeking care for gender dysphoria and the limited number of health care providers who are able to provide care to these patients.
“Because of this lack of education and clinical exposure, relatively few providers have the knowledge and experience to provide quality care to patients, yet we have over a million individuals in the United States who identify as transgender or gender non-binary,” said Newsome.
In 2015 the University of New Mexico Hospitals opened a clinic solely dedicated to providing interprofessional medical and behavioral health services to TGNC patients, which was the first clinic of its kind in the entire state. Before the clinic opened, very few options were available and there were no options where all needs of a transgender patient could be found in one place.
THE ROLE OF THE PHARMACIST IN PROVISION OF CARE
Newsome has been studying the pharmacist’s role in providing care to TGNC patients within a “medical home” model of care, a topic on which she recently published with three co-authors in the American Journal of Health-System Pharmacy.
The medical home model of care is designed to be patient-centered and provide comprehensive care. For example, the team at the New Mexico clinic that Newsome writes about includes a clinical pharmacist, a psychiatrist, a nurse practitioner, an endocrinologist, a diabetes educator, a massage therapist, a nurse, a nutritionist, and medical assistants.
“We had many providers in one building who could take care of most of the patients’ physical and mental health needs. Having all their providers in one place and sharing one medical record allows for collaborative care between health professions. It’s also easier to navigate for patients, everything is in one place,” said Newsome.
The team also approached patient consent differently with an “informed consent” model, which follows the traditional patient consent process but emphasizes the importance of the health care provider to also serve as patient advocate.
“The informed consent model of care eliminates gate-keeping. The goal is to prevent unnecessary screenings which delay patients from getting the care they need. Access and availability to care are of great importance for TGNC patients because gender dysphoria can lead to self-harm if untreated,” said Newsome.
Newsome received her Doctor of Pharmacy degree from Southern Illinois University and is a licensed pharmacist in Illinois, New Mexico and Washington. She is also a licensed pharmacist clinician in New Mexico, which means she can write prescriptions, make medication changes and order laboratory tests as outlined in the state’s governing collaborative practice protocol.
According to her AJHP article, this advanced scope of practice allows pharmacists who have the expertise and desire to expand access to care for TGNC people.
“As the drug experts and as clinicians, pharmacists are the ideal health care professional to discuss hormone therapy with patients,” said Newsome. “Pharmacist can be medication problem solvers and creatively aid patients through medication—and other chronic disease state—management.”
Newsome discovered her interest in this area of pharmacy during her post-graduate residency at the gender clinic in Albuquerque. Prior to that, she had not heard of or been involved in this type of specialty care.
“During my second year of residency I worked with a pharmacist in her gender dysphoria clinic. Hearing stories of the patients with gender dysphoria and providing them gender-affirming care was an extremely rewarding experience,” she said.
Now, Newsome is bringing this knowledge to Washington.
“There is definitely a need here in Washington. In Washington state, insurance health care plans are required to cover medical expenses for gender dysphoria. So the payer is there, we just need to get trained providers,” says Newsome.
LOCAL EXPERT, NATIONAL LEADER
“Before I started working in the New Mexico clinic I had received no education on medical care for transgender or gender non-conforming patients,” said Newsome. “And I know this is true for the vast majority of health care providers out there.”
This marked the beginning of her journey to increase pharmacists’ and other health professionals’ knowledge about TGNC people and their health care needs. The next step for Newsome includes pursuing a new project at WSU that will increase the amount of education the College of Pharmacy offers around caring for LGBTQ people.
Newsome has given several lectures to professional organizations on the subject of TGNC care, including the Washington State Psychological Association and the Spokane Pharmacists Association. She will take the national stage in August when she presents for the American Society of Health-System Pharmacists, and then again in December at the organization’s Midyear Clinical Meeting in Orlando, Florida.
“My favorite part about working in the gender clinic was getting to advocate for people, ensure that patients have access to the health care they need, and providing them the tools to be their true self and their best self,” said Newsome.
Newsome joined the faculty at the WSU College of Pharmacy in 2016. In addition to teaching pharmacotherapy, she maintains a practice site at the Mann-Grandstaff Veterans Affairs Medical Center in north Spokane. Here, she runs a metabolic clinic where she sees patients with diabetes and other cardiovascular risk factors. As a pharmacist provider, Newsome operates under a protocol which allows her to initiate, adjust and discontinue medications.
[Lori J. Maricle] 6/30/17]