The Hospital Pharmacist’s Role In 2SLGBTQ+ Inclusive Patient Care 

June 6, 2023
By Jessica Sheard
 
 
Have you ever had an awkward, uncomfortable, or outright negative experience accessing healthcare? During a hospital or clinic visit, have you been refused care, spoken to with harsh or abusive language, or asked personal questions completely unrelated to your medical concern? Have you experienced having to teach your healthcare providers some, or a lot, about your medical conditions? This is an unfortunate and very common reality for many 2SLGBTQ+ patients when seeking medical care. 2SLGBTQ+ patients frequently report experiencing discrimination, prejudice, and stigma while trying to access healthcare services. The continued negative interactions that 2SLGBTQ+ people face in healthcare settings can have long-lasting impacts, resulting in these individuals delaying or avoiding future interactions with the healthcare system, and ultimately leading to adverse effects on their health.   

Many patients will have at least one interaction with a hospital pharmacy professional while they are in the hospital, whether it be during the medication history and medication reconciliation process or being educated on their medications. During these interactions, hospital pharmacy professionals are in a unique and important position to ensure that 2SLGBTQ+ patients feel that the care they receive is inclusive and safe. Creating safe and inclusive spaces for 2SLGBTQ+ patients is a cornerstone to providing the best patient care possible. When allowing 2SLGBTQ+ patients to feel safe and heard during interactions in the hospital, they may feel more comfortable sharing more about their health, medical conditions, and medications, allowing for hospital pharmacy professionals to make complete and informed clinical decisions surrounding their medications and care.   

Hospital pharmacy professionals may use several inclusive communication strategies when interacting with 2SLGBTQ+ patients, including offering their own pronouns to patients, asking patients how they would like to be addressed, refraining from using gendered language (e.g. sir, ma’am), and offering sincere apologies when mistakes to names or pronouns are made. Hospital pharmacy professionals can also help to create safe and comfortable spaces for patients by asking questions only relevant to the patient’s medication history and their current medical concerns. Besides interacting with patients in a compassionate and inclusive way, hospital pharmacy professionals and pharmacy departments will ensure 2SLGBTQ+ patients continue to receive medications important for their health and well-being, including hormone therapies used for gender-affirming care. In the spirit of improving equity, diversity, and inclusion, pharmacy departments may also help arrange education for pharmacy staff members on 2SLGBTQ+ health and how to provide equitable and inclusive healthcare to this patient population.  

As medication experts, hospital pharmacists play an important role in the safe and effective use of medications for 2SLGBTQ+ patients in the hospital setting. Hospital pharmacists are often monitoring results of blood work and their associated lab values to ensure patient safety. As such, hospital pharmacists will need to familiarize themselves with clinical guidelines and monitoring parameters for the care of 2SLGBTQ+ patients, particularly for transgender patients receiving hormone therapy.  Lab values that hospital pharmacists are commonly monitoring include blood cell counts, lipid panels, liver function tests, kidney function tests, and electrolytes. Hospital pharmacists will rely on lab reference ranges derived from clinical data to guide their monitoring.  This, however, is a clinically challenging area for the monitoring of transgender patients, where some values may resemble their sex assigned at birth, while others may resemble that of their gender identity. In these instances, hospital pharmacists will rely on the limited clinical data available, as well as their own clinical judgement of the patient’s health status.  

Other important potential safety considerations made by hospital pharmacists in the care of 2SLGBTQ+ patients include kidney function assessment for the dosage adjustment of medications and venous thromboembolism (VTE) risk assessment. Assessment of kidney function is another complex area in transgender patients on hormone therapy, but interestingly, data suggests that lab values more closely reflect their gender identities, rather than their sex assigned at birth. Reducing risk of venous thromboembolism in transgender women on estrogen therapy is another complex and controversial area where hospital pharmacists may be involved. Although VTE prophylaxis should still be considered where indicated, hospital pharmacists will be involved in assessing clot risk based on lifestyle factors, length of estrogen therapy, and patient age. In the perioperative setting, hospital pharmacists can help in the informed consent discussions surrounding holding or continuing estrogen therapies based on perioperative clot risk.  

Hospital pharmacy professionals are in an excellent position to provide equitable and inclusive patient care to members of the 2SLGBTQ+ community while they are in hospital and can do so in a variety of ways. The first step to providing equitable and inclusive patient care lies in creating a safe space for our 2SLGBTQ+ patients. Hospital pharmacy professionals may have one or many interactions with a patient throughout their hospital stay where they can create a safe space and establish a positive and open patient-provider relationship.  Individual or department-wide education on 2SLGBTQ+ health, terminologies, and communication strategies can help in this process. Ensuring the safe and effective use of medications is always at the forefront of a hospital pharmacist’s work in the hospital. This is no exception in the care of 2SLGBTQ+ patients, as hospital pharmacists will use the evidence available to monitor lab values, adjust doses based on renal function, or assess for risk of venous thromboembolism and postoperative clot risk.   

Jessica Sheard is a PharmD class of 2023 graduate from the University of Saskatchewan. Her interest in equitable and inclusive pharmacy practice drives her to provide optimal patient care.