Acceptance, Use and Barriers of Telemedicine in times of SARS-CoV-2 in Transgender Health Care: Results of a nationwide cross-sectional survey.

Abstract

BACKGROUND\nThe global incidence in the treatment of transgender people is increasing. In the COVID-19 pandemic, many consultations had to be cancelled, postponed or converted to a virtual format. Telemedicine in transgender health care management could support physicians.\n\n\nOBJECTIVE\nThis study analyses the acceptance, use and barriers of telemedicine in times of SARS-CoV-2 in transgender health care in Germany.\n\n\nMETHODS\nThis prospective cross-sectional study was based on a survey of gynaecological endocrinologists and transgender patients in Germany during the COVID-19 pandemic undergoing gender-affirming hormonal treatment. Descriptive statistics were calculated and regression analyses were performed to show correlations.\n\n\nRESULTS\nWe analysed responses of 269 transgender patients and 202 gynaecological endocrinologists treating transgender patients. Most believed that telemedicine was useful. Physicians as well as patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they do not currently use telemedicine, although would like to do so. Patients and physicians reported that their attitude had changed positively towards telemedicine and that their usage had increased due to COVID-19. The majority in both groups agreed on implementing virtual visits in stable disease conditions. In the treatment phases, 74.4% (150/202) of the respondents would use telemedicine during follow-up. Half of the respondents would choose telecounseling as a specific approach to improving care (128/202, 63.2%). Obstacles to the introduction of telemedicine include the purchase of technical equipment (132/202, 65.3%), administration (124/202, 61.2%) and poor reimbursement (106/202, 52.4%).\n\n\nCONCLUSIONS\nTelemedicine in transgender health care finds limited use but high acceptance among doctors and patients alike. The absence of a structured framework is an obstacle for effective implementation. Training courses should be introduced to improve the limited knowledge in the use of telemedicine. More research in teleendogynaecology is needed. These include large-scale randomized controlled trials, economic analyses and the exploration of user preferences.