Pride in Idaho Care Neighborhoods

Description

Patients who identify as LGBTQ+ in rural communities may face barriers to receiving needed care, including stigmatization and a knowledge gap among rural primary care providers when it comes to HIV prevention, as well as hormone replacement therapy and other forms of gender-affirming care. In Idaho, the late-stage diagnosis rate for HIV is approximately 40%, four times higher than in neighboring states.

To ensure that LGBTQ+ people in rural Idaho are able to comfortably and safely access care, Idaho-based nonprofit Cornerstone Whole Healthcare Organization (C-WHO) partnered with Valor Health (a Critical Access Hospital) in Emmett, Idaho, Full Circle Health, the University of Utah, Cambia Health Foundation, and others to create the Pride in Idaho Care Neighborhoods (PiICN) Project. The goal of the PiICN Project is to establish a replicable and scalable care model to reduce stigmatization and improve health outcomes for LGBTQ+ patients in rural communities across Idaho.

Services offered

Rural physicians with patients who require pre-exposure prophylaxis (PrEP) treatment for HIV prevention, hormone replacement therapy, or other forms of gender-affirming care may not feel sufficiently knowledgeable about these types of care to provide these services themselves. In such cases, rural doctors can request a virtual consultation with another Idaho-based physician with expertise in providing care and teaching rural residents these skills. Consultations take place during the patient's appointment and allow the patient to receive appropriate care while remaining under the care of their primary care doctor and without needing to travel. Consultations may be one-time calls to establish a care plan, or ongoing calls to co-manage a patient's care long-term. This service is available to any rural physician in the state.

The PiICN Project has additionally held trainings for rural providers in PrEP management and in the principles of the Family Acceptance Project, a national initiative to support and prevent health risks for LGBTQ+ children.

To share best practices and lessons learned during the implementation of PiICN, project leaders published the Pride in Idaho Care Neighborhoods Roadmap. The PiICN Project also published a Resource Library for individuals, health care providers and systems, and non-clinical partners with resources "to support communities across the state and country in developing more inclusive, safe, and culturally appropriate care environments for LGBTQ+ individuals."

Results

Virtual consultations are now available to any rural physician in Idaho. The PiICN Project is working directly with three Critical Access Hospitals around the state to implement the model, and continues to look for opportunities to work with health systems in other Idaho communities. Five physicians have utilized virtual consultations, with another 20 expected to receive training within the next year.

The PiICN Project has trained more than 80 providers and staff in the tenets of the Family Acceptance Project and doubled the number of local providers trained in PrEP management.

Challenges

The first meeting of PiICN consortium members generated interest from community partners, but momentum dwindled in the following months due to a lack of concrete data to identify areas of greatest need. To give the consortium a clearer sense of direction and launching point, project leaders conducted an assessment of need within the local community several months after the group's initial meeting, renewing the project's momentum.

The PiICN Project was initially designed around in-person meetings and trainings, but COVID-19 precautions forced project leaders to pivot to virtual sessions and gatherings. Remote meetings and trainings may be more convenient for rural consortium members and trainees but are not recommended by project leaders, who say in-person meetings and trainings foster more personalized and connective interactions.

Replication

For those interested in creating similar programs, some best practices recommended by PiICN Project leaders include:

• Start with data to clearly establish need and project goals.
• Begin conversations with healthcare providers with a basic discussion of language and its importance in treating LGBTQ+ patients.
• Make sure entire healthcare provider teams – not only one "provider champion" – are trained in caring for LGBTQ+ patients.
• Have local presenters host trainings when possible.

Contact Information

Rachel Blanton Harris, Chief Operating Officer
Cornerstone Whole Healthcare Organization, Inc.
Pride in Idaho Care Neighborhoods
RachelBH@c-who.org