Focusing on healthcare access for LGBT & TGNB individuals during the pandemic

“I’ve been working with Labcorp to make sure that our patient service sites in the New York City area have had some specific training around taking care of LGBT and particularly TGNB (transgender and gender non-binary) patients. It’s been very exciting to see this progress. We’ve now been partners with Labcorp for a number of years.” — Dr. Peter Meacher

Labcorp’s Dr. Brian Caveney conducts a fireside interview chat with Dr. Peter Meacher of Callen-Lorde Community Health Center.

Dr. Brian Caveney (left) and Dr.  Peter Meacher (right)

Question

Dr. Caveney: As most people will remember, the Greater New York City area was absolutely the epicenter of the pandemic, not just of America, but of the whole world in the very early days of March, April 2020. What was it like working with your clinicians and staff taking care of these scared patients?

Answer

Dr. Meacher:  Yeah, it was quite a journey. I remember bringing to the attention of our staff that we needed to start screening people as they enter the building. This was something we’d never done before because part of a community health center’s ethos is that it should be a welcoming, open place.

That was the first sort of huge shift in the way we did things that was so necessary. I remember very clearly the first positive test result that we got back on a patient and the cascade of things that were triggered by that because the visit had occurred in the days before we were doing the screening. It meant that everyone who’d come in contact with that patient had to be quarantined and sent home, and patients who had been in contact with that patient, the same thing. It was really a sort of a gradual—but not so gradual—dawning that the world has changed and something major is happening.

Question

Dr. Caveney: Are there any specific issues that are different in the LGBT community surrounding COVID: the likelihood of being tested or the panoply of symptoms that they experienced, or any other clinical manifestations that your teams had to think through in addition to the standard COVID treatment protocols?

Answer

Dr. Meacher:  In the LGBT community, something we are very familiar with both pre-pandemic and especially during the pandemic is that some of our patients are extremely reticent to go anywhere except our health center. In a pandemic, that was just the same. They just felt really, really uncomfortable going anywhere except to us.

To illustrate the point, I tell a story about something that happened to me when I was in the South Bronx. You have to imagine a busy community health center waiting room. Patients sign in and then the nurse would call them back. I had started building a practice for transgender and gender non-binary patients. I had a patient who was a trans woman who presented dressed as a woman and her whole identity was female. Yet her insurance card had not been changed, because at that time it was very difficult to change legal gender.

Unfortunately, we had not realized all of the things that make the experience for a transgender person really difficult in our health systems. On the sign-in there was no option to say, “This is my insurance name, but this is the name I go by.” So, the nurse called the patient to the back with a male name. This individual had to stand up, walk across the room and go to the back. Now, you might instantly think that felt really awful and humiliating, but it’s much more than that. Violence against transgender people is many, many fold more [common] than in the general population.

I have no idea who else was in that waiting room who might have taken issue with this individual, who might have waited outside for them when they left. You can understand why many people will only go to a medical home they trust such as Callen-Lorde and will delay getting really important medical care elsewhere.

Question

Dr. Caveney: It’s a safe environment. The staff is both culturally competent [and] clinically competent for the different clinical situations that arise. At Labcorp, we try to train all of our staff who are patient-facing to be culturally competent. But you’re right, we can’t control who else is in the waiting room at that particular time and want to make sure that we have a safe and inviting environment for patients.

Answer

Dr. Meacher: To that point, I’ve been working with Labcorp to make sure that our patient service sites in the New York City area have had some specific training around taking care of LGBT and particularly TGNB (transgender and gender non-binary) patients. It’s been very exciting to see this progress. We’ve now been partners with Labcorp for a number of years. And I have to say, we were one of the first FQHCs, I believe possibly the first in the city, to get any type of testing back in March [2020], and that was through Labcorp. It was the old fashioned, right-to-the-back-of-the-nose swabs, but nonetheless, we got that up and running ahead of almost all other FQHCs. I’m very proud of that. Also, we’ve really embraced the Pixel by Labcorp home testing because that has been another way to get appropriate tests to patients and save them a visit to a site that might expose them to COVID. That was another strategy that we got up and running and embraced pretty early on.

Question

Dr. Caveney:  When a vaccine became available, how did you make those decisions for your patients? It’s incredibly difficult to make triage decisions when you have limited resources.

Answer

Dr. Meacher: When it became clear that as a federally qualified health center we were going to be used for vaccine distribution, we quickly started to think about how we were going to do this, and how we were going to do this thinking about equity and the disenfranchised groups of the patients we serve. We came up with an algorithm whereby we took all of our 18,000 patients and we attributed a point system to them based on age, chronic illness, race, ethnicity, poverty and a number of other things.

In doing that, we identified 1,400 of our highest risk patients, and we made those patients a priority and did our very best to get them in first and get them vaccinated first. As soon as we explained the reason we were doing this and that there would be vaccines for everyone who’s willing to have it, but we were focusing on getting the vaccine to the people who stood to lose the most first, other patients were very understanding and supportive.

Question

Dr. Caveney: If one of your patients needed non-COVID standard lab testing, were you able to order that during a virtual healthcare visit, and then be able to close the loop, if you will, and then take care of your patient, change clinical management, whatever needed to be done treatment-wise based on the results?

Answer

Dr. Meacher: Yeah, absolutely. Prior to the pandemic, we really didn’t send any patients to lab patient service sites. We would do all of our lab draws onsite. This was all new for us, but we had the interfaces set up and so we were able to go live coinciding with the video visits. And remember, I’d mentioned we’re a magnet site, so often people were quite far from our actual physical site, and so it really made no sense for them to come all the way to us to get their labs when there was a Labcorp patient service site two blocks away.

I think the pandemic has really opened up a new way of interacting with patients. I really like to see it as an expansion of services providing more access, more choice for patients. It doesn’t work for everybody, and we should never have any service line that you can only access through the video platforms. Not everyone has adequate bandwidth. Some people don’t have the tech-savviness, some people don’t have the hardware. So, whatever we do, I’m really committed to making sure that we have multiple ways patients can get the same service, but to try to include the video option and patient service sites for labs as one of those modalities, when it’s appropriate.

“… we were one of the first FQHCs, I believe possibly the first in the city, to get any testing back in March [2020], and that was through Labcorp.” – Dr. Peter Meacher

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