Leveraging pharmacists' scope of practice to improve access to gender-affirming care: A scoping review

Background

Transgender and gender-diverse (TGD) individuals experience health inequities at a substantially higher rate than their cisgender counterparts. Gender-affirming care (GAC) is a lifesaving measure that encompasses a range of social, psychological, behavioral, and medical interventions designed to affirm an individual's gender identity. Access to GAC is limited worldwide and pharmacists may be optimally situated to bridge this gap.

Objectives

To determine strategies to improve access to GAC within community pharmacists' scope of practice for TGD patients.

Methods

This was a scoping review of published literature. Three databases (PubMed, Embase, and CINAHL) were searched and supplemented with a manual citation to yield 324 articles. Articles were included if they described or evaluated GAC services performed by pharmacists. Screening and extraction were conducted independently by two reviewers. Extracted data was mapped into six categories (prescribing, monitoring, patient education and counseling, healthcare advocacy, interprofessional and collaborative care, and non-pharmacological), which were identified during the extraction process to represent GAC initiatives.

Results

Twenty-one articles met the inclusion criteria from the 324 articles initially screened. Most articles were published in the United States (n = 17). More than half of the articles described prescribing (n = 12), monitoring (n = 15), and patient education and counseling (n = 17). Healthcare advocacy was mentioned in 9 articles, with interprofessional and collaborative care being mentioned in 8 articles. Non-pharmacological care was the least mentioned among the six categories (n = 2).

Conclusions

Current literature shows that pharmacists' scope of practice can be leveraged to provide GAC through prescribing medications, monitoring therapy, educating and counseling patients, advocating for TGD individuals within the healthcare system, providing collaborative care, and through the provision of non-pharmacological GAC options.