Challenges of Engaging and Maintaining Care for LGBTQ Patients: Case Studies

Cristina: Overcoming Accessibility and Treatment Concerns

Cristina minimal and she tells you she needs money to complete her transition so she started doing sex work.  

She came in today because when she went to a free mobile clinic in the Bronx , where she often sees her clients, to get condoms and a rapid  HIV test, she did a screening for blood pressure and diabetes and  her blood pressure was 160/90 and she was told she was pre-diabetic.  She is very anxious about her health but has never had a regular PCP because she was afraid of insensitivity to her gender status. She is also anxious taking medications that might interfere with her transition or impact upon her appearance. She reveals that she is often depressed, when she worries about her future and now even more so now that she might have diabetes and because of her past experiences, she sometimes has nightmares. She came to your health center because some friends told her it was a good place for the LGBT community.

What are the challenges and potential barriers to engaging and maintaining this patient in care?

What kind of screenings and assessment should be done and what is the best way to engage her in that process?

How do you handle her concerns about treatment?

What would be the most effective preventive and treatment plan/approach for her care?

What potential referrals might you make and where?

Bob is a 75 year old gay man who has been hospitalized for observation after being evaluated in the ER when he was brought in by ambulance because he collapsed in the street with severe chest pain and elevated blood pressure.  His partner John has arrived and has been visiting him in his hospital room.  The Nurse Manager on the floor calls you to report that the patient in the other bed has made a complaint that he should not have to watch two “homosexuals kissing and touching each other”  in front of him and his visitors .

What policies would cover this situation?

How should the hospital handle this situation?

What action would you take?

Claudette is a 35 year old woman who was referred to your health clinic  for follow up care after she spent the night in the Emergency Room with severe stomach cramps and vomiting. She was diagnosed with food poisoning but had elevated blood pressure and revealed to the ER provider that she had not seen a physician for a physical in over ten years. She left the sexual orientation question on her patient self assessment form blank but did report herself as recently married to her wife Marie.  They live in Brooklyn but she tells you she came into Manhattan for her physical because she doesn’t want anyone her neighborhood to “be all up in my business”.

What are the challenges and potential barriers to engaging and maintaining this patient in care?

What screenings and assessment should be done and what is the best way to engage her in that process?

How do you handle her concerns about treatment?

What would be the most effective preventive and treatment plan/approach for her care?

What potential referrals might you make and where?