Evaluating a co-designed shared care model of care on the quality of life of patients accessing gender affirming hormone therapy

The shared care model of care co-design process was completed in 2023 with input from trans community members, GPs, practice manager, rural trans community organisations and primary care health networks in rural Victoria. Current standard of care involves being on a waiting list for 9 months to access specialised gender clinics in Melbourne where initiation and monitoring of hormone therapy is provided by the specialist gender clinic without expectation of the GP to provide significant input. Patients often travel long distances to access care from rural Victoria to metropolitan Melbourne Victoria. The intervention will be the shared care model of care. The shared care model of care will be available to patients living in rural Victoria (Modified Monash Model Remoteness Areas 2 - 7). It will actively involve their local rural GP alternating consultations with the specialist gender clinic whilst the local rural GP concurrently is supported with an existing training course in gender affirming care (run by Thorne Harbour Health), existing training resources (AusPATH informed consent standards of care, HealthPathways, Transhub website) and the specialist gender clinic endocrinologist. Patients will be supported by a peer navigator and also connected to local rural trans organisations if available in the patient's location of residence. Clinic visits will be one-on-one and occur 3 monthly for 24 months but alternate between the specialist gender clinic endocrinologist via telehealth and the local rural GP face-to-face, The frequency of clinic visits with specialist gender clinic endocrinologist gradually decreases whilst clinic visits with the local rural GP gradually increases over the 24 month period. The shared care model of care will be facilitated by a specialist gender care nurse and adherence by the GP and patient will be supported by session attendance checklists. Both patients and their GPs will provide consent to participate in the shared care model of care.