P4A227: Pediatric Gender Care in Primary Care Settings in West Virginia: Comfort & Preference for Consultative Support Resources

Background: Gender diverse youth (GDY) and their families often present to pediatric primary care providers (PPCPs) seeking support and guidance. GDY face increased health disparities compared to cisgender peers, but gender-affirming care is associated with significant reduction in these disparities. Studies suggest that between 7-9% of Appalachian youth have a gender diverse identity, and in this predominantly rural region, GDY may be more likely to seek this care from their PPCP. Little is known about PPCP comfort with providing gender-affirming care or the modalities PPCPs desire for education and support related to this care. This study aimed to examine comfort in providing gender-affirming care and interest in consultative support modalities among PPCPs in the Appalachian state of West Virginia (WV) by time in practice and training background.

Methods: PPCPs across WV completed a 76-item anonymous online survey distributed through professional organizations in the winter and spring of 2021-2022. Questions included items measuring PPCP comfort related to the provision of gender-affirming care and practicality of consultative support modalities related to this care. Descriptive statistics were used to characterize the sample and summarize responses to survey items of interest. Next, t-tests were used to compare comfort providing gender-affirming care if given access to consultative support by years of experience providing pediatric primary care. Finally, rank-sum tests were used to identify differences in rankings in the practicality of four consultation methods (Tele-education/ECHO, electronic, telephone, telemedicine) among physicians by specialty training.

Results: A total of 51 providers completed the survey. Most identified as female (62.8%), and mean age was 40 years (SD=11.9). The sample was relatively evenly split between PPCPs who had < 10 (47.1%) and 10+ (54.9%) years of experience. Most were physicians (92.2%), and of these, 59.6% specialized in pediatrics and 40.4% specialized in family medicine. T-tests indicated that less experienced PPCPs were more likely to agree that they would feel comfortable monitoring, refilling, and initiating gender-affirming medications compared to more experienced PPCPs (Table 1). Less experienced PPCPs were also more likely to agree that they would feel more comfortable supporting GDY with access to electronic and telemedicine consultation. When asked to rank consultation methods, those trained in family medicine ranked e-consultation, and those trained in pediatrics ranked telemedicine, as more practical (Table 2).

Conclusion: PPCPs are increasingly caring for gender diverse youth in their practices, particularly in rural areas. WV PPCPs endorsed variable levels of comfort with providing aspects of gender-affirming care, and their perspectives on the practicality of specific consultative support modalities aligned with their time in practice and training background. These results can be used to identify and design practical consultative support modalities to improve health outcomes for GDY in rural areas and beyond.