O4311: Evaluating an Electronic Consultation Platform to Support Pediatric Primary Care Providers in Caring for Transgender and Nonbinary Adolescents

Background: Gender-affirming medical care has been shown to improve mental health outcomes for transgender and nonbinary (TNB) adolescents, however many are unable to access this care due to the limited number of clinicians providing it. Electronic consultation (e-consult) has shown great promise in providing PCPs with timely, patient-specific consultative support, and has been used to support care provision for TNB adults but not adolescents. We implemented an e-consult platform to support PCPs in caring for TNB adolescents. Following its implementation, we conducted a study to 1) explore how access to the e-consult platform impacted PCP confidence and specialty referral patterns, 2) describe the content of clinical questions submitted, and 3) evaluate PCP’s perspectives regarding platform usability.

Methods: The e-consult platform was designed in partnership with PCP stakeholders using EpicCare Link. PCPs submitted consult questions which were addressed by a multidisciplinary pediatric gender clinic team within 3 business days. Following each e-consult submission, providers were emailed a 17-item follow up survey to evaluate the impact of e-consult use on patient management, referral patterns, and overall platform usability using the validated 10-item system usability scale (SUS). Survey data were analyzed descriptively. Submitted consult questions were individually coded to identify key content areas based on a pre-determined codebook and analyzed using inductive thematic analysis methods.

Results: Providers submitted 38 e-consults and completed 26 follow up surveys between October 1, 2021 and December 31, 2022. Question content was most frequently related to initiating puberty blockers (26%) or gender-affirming hormones (26%), followed by determining whether to initiate puberty blockers or hormones (18%; Table 1). Survey responses indicated a high overall value of the e-consult, both to PCPs themselves (mean: 5 out of 5) and the patient for whom the consult was submitted (adjusted mean: 4.8/5). All providers (100%) reported that having access to the e-consult platform made them feel more confident caring for other TNB adolescents in their practice (Table 2). A majority of providers (81%) felt they ‘got new advice for a new or additional course of action’ and for 19% a referral was originally contemplated but was able to be avoided because of the e-consult. The mean usability score on the SUS was 78.2, indicating good overall usability.

Conclusion: This e-consult platform shows great promise in increasing pediatric PCP confidence providing gender-affirming care to TNB adolescents in pediatric primary care. Access to this platform may decrease referrals to pediatric gender clinics as PCPs become more comfortable providing this care. More widespread access to such platforms could improve health outcomes by making gender-affirming care more accessible for TNB adolescents, especially those who currently experience barriers to receiving specialty care in pediatric gender clinics.