Doctoral student Chase Harless publishes two articles
Chase Harless, doctoral student in East Tennessee State University College of Public Health’s Department of Community and Behavioral Health, has co-authored two articles.
Dr. Irene Ulrich of the Mountain Area Health Education Center is lead author of the first article, Implementation of Transgender/Gender Nonbinary Care in a Family Medicine Teaching Practice, published in the Journal of the American Board of Family Medicine. Chase Harless is a co-author along with other members of the Mountain Area Health Education Center.
Numerous studies have shown that transgender or gender nonbinary (TGNB) individuals encounter significantly more health care barriers, including overall lack of access to gender-affirming care providers. This study describes two assessments of transgender care services at a large family medicine teaching practice.
Staff and providers were invited to attend an optional, practice-wide, hourlong free training session on gender-affirming care offered on 3 different dates in 2019. A structured protocol was used to collect observational data from which key takeaways from the training sessions were developed. Separately, a retrospective chart review of patients with a gender dysphoria diagnosis was completed. Charts were reviewed for adherence to regional and international organization recommendations for comprehensive transgender care.
Three main takeaways from the training sessions included lack of knowledge or familiarity with gender terminology and expression, fear of offending patients, and employee hesitation to change behaviors when interacting with patients. This study highlighted hesitation to provide and lack of familiarity with transgender care among practice staff. Although some aspects of comprehensive transgender care are well implemented, maintaining follow-up, completing health maintenance and mental health screenings, and appropriate laboratory monitoring are areas for improvement.
Ana Cabello-De la Garza of the Mountain Area Health Education Center is lead author of the second article, Increasing North Carolina’s Workforce Capacity for Prescribing Buprenorphine Products, published in the North Carolina Medical Journal. Chase Harless is a co-author along with another member of the Mountain Area Health Education Center and a faculty member at the Boston University School of Medicine.
Inadequate access to opioid use disorder treatment is a public health concern. Rates of opioid-related poisoning deaths are increasing in North Carolina and access to OUD treatment is especially sparse in rural areas. DEA-X-waivered providers that can prescribe buprenorphine as a medication for opioid use disorder play an essential role in treating opioid use disorder. Increased workforce capacity to treat the disorder in an evidence-based, equitable, and patient-centered way is needed. Gaps persist in continuing professional education and academic training.
In the context of opioid-related overdose deaths and inadequate access to evidence-based treatment options for many North Carolinians, the North Carolina Department of Health and Human Services contracted with the Mountain Area Health Education Center to train medical residents and advanced practice provider trainees in necessary skills for opioid use disorder treatment. With the goal of sustainably embedding medication-assisted training education in medical residency and advance practice provider curricula, from November 2018 through October 2019 UNC Health Sciences at MAHEC educators and staff designed and implemented trainings and technical assistance.
Engagement exceeded initial goals: 72 unique trainings related to medication-assisted training were administered to 1,512 providers from 30 residency and seven advanced practice provider programs. By the end of the grant period, 902 participants completed a training required to obtain a DEA-X waiver. This project highlights a successful and potentially replicable approach to offering structured medication assisted treatment capacity-building training in combination with technical assistance within medical education programs.