Most PCPs strive to offer LGBTQ+-affirming care, but ‘there is still a lot of work’ to do

ByAndrew (Drew) Rhoades

Fact checked byMindy Valcarcel, MS

Key takeaways:

Under 40% of practices provided LGBTQ+ competency training to their clinicians and staff.
Such stigma and inequities can have significant impacts on the health of LGBTQ+ populations.

Most primary care practices collected data on sexual orientation and gender identity, or SOGI, a cross-sectional study indicated.

However, few practices provided their clinicians and staff with training on LGBTQ+ care, revealing that “gaps exist,” Ellesse-Roselee L. Akré, PhD, MA, an assistant professor at Johns Hopkins Bloomberg School of Public Health, told Healio.

PC0325Akre_Graphic_01_WEB — Data derived from: Akré E, et al. *JAMA Netw Open*. 2025;doi:10.1001/jamanetworkopen.2025.0392.

Akré said the data “were encouraging in many ways because they demonstrated that we have made improvements in collecting SOGI data in clinical settings."

“Knowing more about patients — any and all patients — helps ensure that clinicians provide informed, quality care,” she added. “On the other hand, the results demonstrate that there is still a lot of work that needs to be done to create inclusive and affirming spaces for LGBTQ+ patients and meet their unique health care needs.”

According to Akré and colleagues, LGBTQ+-affirming care — which can include collection of data on SOGI and pronouns, LGTBQ+-friendly policies and training, and appropriate language and services — “is an approach to health care that validates and supports the identities, experiences and needs of LGBTQ+ individuals.”

But “to our knowledge, no national data exist on primary care practices’ efforts to ensure high-quality care for LGBTQ+ patients,” they wrote in JAMA Network Open.

The researchers examined the percentages of practices that engage in several LGBTQ+-affirming activities, as well as characteristics tied to a higher likelihood of performing such care.

Practice data utilized by Akré and colleagues in their analysis were taken from the National Survey of Healthcare Organizations and Systems II, administered from June 2022 through February 2023.

Of 1,245 practices included in the study sample:

77.4% collected data on gender identity;
75.62% collected data on sexual orientation; and
65.83% collected data on patients’ pronouns.

However, only 34.42% and 39.2% of practices provided LGBTQ+ competency training for clinicians and staff, respectively, while fewer reviewed performance measures by patient sexual orientation (19.89%) and reviewed measures at the system level (28.99%).

Over half of practices (55.77%) gave referrals to providers specialized in treating LGBTQ+ patients.

“It seems like a missed opportunity to identify and address areas to improve care quality for LGBTQ+ populations,” Akré told Healio.

The researchers also reported that practices designated as federally qualified health centers, or FQHCs, were 3.16 (95% CI, 4.6-19.73) percentage points likelier to engage in all SOGI-affirming activities vs. non-FQHCs.

Practices with a Medicaid payer mix of at least 50% were 3.28 (95% CI, 1.19-5.36) percentage points likelier to engage in such activities compared with practices with less than 50% Medicaid payer mix.

Akré and colleagues noted that each 1-unit increase in the state-level LGBTQ+ Equality Score was tied to a 1.07 (95% CI, 0.28-1.85) percentage point higher likelihood of engaging in all SOGI-affirming activities.

Akré said clinicians can use the study findings “to gauge where they stand compared with their counterparts in primary care."

“They can also see how pervasive many of these gaps are, and they can be encouraged to adopt practices, even if they still need improvements,” she added.

Akré also pointed out that the results have major health implications, as LGTBQ+ populations “have elevated risk for certain health conditions and reduced life expectancy of up to 12 years when they are exposed to social stigma, structural discrimination and subsequent inequities.

“It is the responsibility of the governing bodies of the primary care and medical education communities to use this information as evidence that requirements and incentives are necessary to ensure clinicians and staff are engaging in training,” she added. “It’s also important that this data continue to be collected to hold practices accountable when patients are receiving low-quality care and have poor patient experiences.”