258721 Less positive experiences for gay, lesbian, and bisexual (LGB) patients in a national survey of English family practices

Tuesday, October 30, 2012 : 9:30 AM - 9:45 AM

Marc N. Elliott, PhD , RAND Health, RAND, Santa Monica, CA
Q. Burkhart , RAND Health, RAND Corporation, Santa Monica, CA
David E. Kanouse, PhD , RAND Corporation, Santa Monica, CA
Gary Abel, PhD , Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
Mark A. Schuster, MD, PhD , Dept. of Medicine, Children's Hospital Boston/Harvard Medical School, Harvard University, Boston, MA
Megan Beckett, PhD , RAND Health, RAND Corporation, Santa Monica, CA
Martin Roland, MD, FMedSci , Chair in Health Services Research, University of Cambridge, Cambridge, United Kingdom
Using data from more self-identified LGB respondents than in any known health survey, we assess whether patients' healthcare experiences differ by sexual orientation among the 2,169,718 respondents to the 2009-2010 English General Practice Patient Survey (8,362 practices).

We used linear regressions (separately for men and women) to predict four measures of patient experience (doctor communication, nurse communication, trust and confidence in the doctor, and overall satisfaction with care) from self-reported patient sexual orientation (lesbian, gay, bisexual, heterosexual), location, and socio-demographic characteristics.

Compared with heterosexual patients, LGB patients reported less positive healthcare experiences on all four measures by 1-3 percentage points (p<0.05). Disparities were larger for gay men than for bisexual men on 3 of 4 measures, whereas bisexual women reported larger disparities than lesbian women on all 4 measures.

The average disparities within practices are very similar to overall disparities, with little evidence of concentration of LGB subgroups in low-performing practices. Disparities varied considerably across practices, with no disparities in some practices and much larger than average disparities in others. Disparities were largest and most variable across practices for trust and confidence in the doctor. Differences by sexual orientation were largest in London (up to 5 percentage points) and in socioeconomically deprived areas. No differences in care were reported by LGB patients in rural areas or by affluent LGB patients.

Efforts should be made to improve the experiences of LGB patients, with particular emphasis on low socioeconomic status areas.

Learning Areas:
Communication and informatics
Diversity and culture

Learning Objectives:
1. Compare experiences of patients by sexual orientation 2. Name LGB patients with the least positive healthcare experiences

Keywords: Health Disparities, Patient Satisfaction

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have 16 years’ experience and nearly 100 peer-reviewed publications in the area of patient experience of health care in the US and the UK and more than a dozen publications regarding LGBT health issues. Co-authors include nationally recognized leaders on LGBT health issues and served recently on an IOM panel on LGBT health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4050.0: LGBT Health Emerging Issues