Page 44 - Delaware Medical Journal - May/June 2020

For example, be sure to ask about a patient’s living situation. If a patient doesn’t have stable housing, or lacks basic amenities such as a refrigerator, it can obviously affect medication adherence, she notes.
You should also probe into access to transportation, access to food, and whether the patient is exposed to violence at home, adds Fink.
Another issue that’s being recognized as more and more crucial is sexual and gender identity. “It’s increasingly important to ask these questions because people’s health risks depend on their birth gender and genetics,” says Fink. “If you have a transgender male, he might have ovaries and might be at risk for ovarian cancer.”
Both Rattay and Fink agree that
it’s crucial to ask every one of your patients about these issues. “Often, providers may think they need to talk to certain patients about certain things, but the reality is we should be talking with all patients about their substance use, emotional and behavioral health, and possible domestic violence,” says Rattay. “These really should be universally incorporated into our assessment.”
The same is true of questions around sexual and gender identity, says Fink. “Getting comfortable with asking
that type of question of all your patients is the best way to make it more comfortable for patients and providers,” he says. “Maybe four years ago, we started really aggressively asking more about domestic violence, and now patients are just used to it. When you ask everybody, it starts to seem like an important question. In the beginning, it seemed a little intrusive, but now, people are used to it. I think the same thing will come about with sexual and gender identity.”
RESOURCES FOR PROVIDERS AND PATIENTS
Having the difficult conversations with patients is one thing — identifying next steps is another. We hope the resources below are helpful in that regard; they were compiled with kind assistance from the Delaware Division of Public Health.
Sexual orientation and gender identity: www.cdc.gov/hiv/ clinicians/transforming-health/health-care-providers/ collecting-sexual-orientation.html
Substance use disorder:
www.helpisherede.com/health-care-providers
HIV testing and linkage to care:
www.delawarehiv.org/physicians-toolkit/recommendations- for-routine-hiv-testing
STD testing:
www.cdc.gov/std/sam/talktesttreat/providers.htm
Family planning:
Delaware Contraceptive Access Now (DE CAN) www.upstream. org/partnerships/delaware-can and Delaware Thrives www. dethrives.com
VALIDATED SCREENING TOOLS:
Screening, Brief Intervention, and Referral to Treatment (SBIRT):
www.samhsa.gov/sbirt
Substance Use Disorder CAGE Screening Tool: www.helpisherede. com/content/documents/cage-aid-questionnaire.pdf
140 Del Med J | March/April 2020 | Vol. 92 | No. 2