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I’m back with the second installation of my summer internship blog series. As we closed out Pride month, I felt compelled to utilize this space to amplify and examine the intersection of the LGBTQ community and the field of pharmacy. Pharmacists’ oft-touted role as one of the most accessible members of the healthcare team uniquely positions them for active improvement of LGBTQ care. This begins with acknowledgment of the barriers to healthcare access traditionally faced by LGBTQ individuals compared to their cisgender and/or heterosexual peers. In educating ourselves on the stigma, discrimination, and suboptimal treatment that LGBTQ patients often experience, we may begin to be instruments of change.

While progress has been made, there is still much to be done. As of 2015, 23% of transgender patients reported forgoing needed healthcare out of fear of mistreatment². Lesbian, gay, and bisexual people are at higher risks for mental health disorders including depression, anxiety, suicidal ideation, and substance abuse³ and have higher rates of chronic conditions⁴. To confound these disparities, LGBTQ people are also less likely to be insured when compared to heterosexual individuals⁴. If these statistics astonish you, I urge you to conduct further personal study, as they only skim the surface. If these facts are familiar yet infuriating, I urge you to endeavor to help change them.

Fortunately, there are inspiring individuals championing these causes. I had the incredible opportunity to interview Dr. Daniel Cobaugh, Editor-in-Chief of AJHP and Vice President of Publishing at ASHP. He created and hosted this year’s ASHP Pride Month Podcast Series – a series of four episodes highlighting “how LGBTQ leaders seek out, grow, and evolve throughout their careers.” This is just one way that ASHP is amplifying the voices of its LGBTQ members. Dr. Cobaugh and I discussed his passion for the project, LGBTQ representation in pharmacy, and future work to be done. Creating and disseminating resources to improve care and inclusion is the responsibility of the individual, educators, and associations. “Providing those resources is part of the role of a professional society - if I'm able to do a little bit to help that in my role at ASHP, I think that's very important,” said Dr. Cobaugh. ASHP provides training resources on care of transgender patients, publishes up-to-date guidelines on pharmacist involvement in HIV care, creates space for discussion through LGBTQ networking nights at Midyear, and fosters an environment dedicated to diversity and inclusion. It follows that this national effort should extend to schools and colleges of pharmacy.

“LGBTQ issues are one piece of a larger effort around diversity and inclusion that we need to ensure is infused in training of new pharmacists in schools and residency programs," said Dr. Cobaugh. In 2013, the AACP CAPE Education Outcomes included “sexual orientation and gender expression as social determinants of health among cultural sensitivity learning outcomes essential to a pharmacist's practice and care approach and thus part of the necessary knowledge and skills for the profession¹." Yet nearly a quarter of transgender individuals report having to teach their providers about transgender care². If you are a pharmacy student or educator, I challenge you to turn a critical eye to your institution. What is being done to include education on LGBTQ care – not in isolated instruction but integrated across the continuum of a student’s academic career? Is bias among the faculty and student body assessed and addressed in meaningful ways? Fostering a workforce of pharmacists confident in LGBTQ care starts at the curricular level. Dr. Cobaugh said it best, "If we start early, we will see a sea change because you, the future generation, can change the minds of people who came before you.”

As students and pharmacists, we must own and practice every day our distinct opportunities for allyship and advancing the health of the LGBTQ community. From providing hormone therapy counseling, aiding in HIV diagnosis and management, and offering informed, unbiased sexual health counseling, to chronic disease management and connecting patients with medication cost assistance programs, pharmacists can create gender affirming spaces for transgender individuals and inclusive environments for all LGBTQ patients.

I leave you with a quote from Dr. Cobaugh’s moving story in Letters to a Young Pharmacist, “As members of a caring profession, it is imperative that we embrace those who are different than we are and, hopefully, come to celebrate those differences.”

 
Delaney McGuirt
ASHP Summer Intern 2020
PharmD Candidate, Class of 2023
University of Maryland School of Pharmacy, Baltimore

Sources:

1. Grundmann O, Segal R, Pullo J, et al. The Pharmacist as an LGBTQ+ Ally. Am J Pharm Educ. 2020;84(60). doi: 10.5688/ajpe7835
2. James S E, Herman J L, Rankin S, et al. Executive Summary of the Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF. Published 2016. Accessed July 1, 2020.
3. King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008;8(70). doi:10.1186/1471-244X-8-70
4. Providing LGBTQ-Inclusive Care and Services At Your Pharmacy. Human Rights Campaign. https://www.hrc.org/resources/providing-lgbtq-inclusive-care-and-services-at-your-pharmacy. Published 2016. Accessed July 1, 2020.