Article type
Abstract
Background: A pressing question, after publication of a clinical practice guideline (CPG), is how well guideline recommendations are adopted in clinical practice.
Objectives: To quantitatively estimate how well the CPG Transgender Somatic Care for Secondary/Tertiary Care (published in 2018) is implemented in the Netherlands
Methods: Nationwide study using several anonymized data sets from Statistics Netherlands (CBS) on transgender status, prescription reimbursement data, national health surveys, and hospital procedure data, covering the total Dutch transgender population who received secondary/tertiary care between 2016 and 2021. Data sets were linked on an individual level. Of 45 recommendations, it was estimated a priori that 8 could be evaluated with CBS data.
Results: Six recommendations could be evaluated. There was an increase of number of visits for transgender persons in secondary/tertiary care over calendar time, ie, from n = 3070 individual visits in 2016 to n = 5774 in 2021 (increase of 88%). Mean age at first intake (21 to 24 years) was stable over calendar time. The following was confirmed (all in line/compliant with guideline-recommendations): 1) In the vast majority, a psychological evaluation within the indication takes place around the intake. 2) Transgender people have a reduced "capacity" (identified with somatic, psychological, and socioeconomic PROMs), which must be taken into account for support in the treatment plan. 3) On average, 1 to 2 years passes between intake and start of hormonal/surgical transition (in line with guideline recommendations, which advocate phasing of treatment). 4) Hormonal treatment is rarely started before the age of 12 (in line with the recommendation that prepubertal/prepubescent children are not treated with cross-sex hormones). 5) Few trans men get pregnant, making a good guideline indispensable for the care of trans men who are or want to become pregnant. One possible discrepancy was found compared with a recommendation—ie, older trans men used cross-sex hormones less often, whereas the recommendation states that there is no reason for older trans men to stop or decrease use of cross-sex hormones. The reason behind this finding cannot be determined with CBS data and deserves further investigation.
Conclusion: This study showed that nationwide registry data can be used for evaluation of CPG implementation.
Objectives: To quantitatively estimate how well the CPG Transgender Somatic Care for Secondary/Tertiary Care (published in 2018) is implemented in the Netherlands
Methods: Nationwide study using several anonymized data sets from Statistics Netherlands (CBS) on transgender status, prescription reimbursement data, national health surveys, and hospital procedure data, covering the total Dutch transgender population who received secondary/tertiary care between 2016 and 2021. Data sets were linked on an individual level. Of 45 recommendations, it was estimated a priori that 8 could be evaluated with CBS data.
Results: Six recommendations could be evaluated. There was an increase of number of visits for transgender persons in secondary/tertiary care over calendar time, ie, from n = 3070 individual visits in 2016 to n = 5774 in 2021 (increase of 88%). Mean age at first intake (21 to 24 years) was stable over calendar time. The following was confirmed (all in line/compliant with guideline-recommendations): 1) In the vast majority, a psychological evaluation within the indication takes place around the intake. 2) Transgender people have a reduced "capacity" (identified with somatic, psychological, and socioeconomic PROMs), which must be taken into account for support in the treatment plan. 3) On average, 1 to 2 years passes between intake and start of hormonal/surgical transition (in line with guideline recommendations, which advocate phasing of treatment). 4) Hormonal treatment is rarely started before the age of 12 (in line with the recommendation that prepubertal/prepubescent children are not treated with cross-sex hormones). 5) Few trans men get pregnant, making a good guideline indispensable for the care of trans men who are or want to become pregnant. One possible discrepancy was found compared with a recommendation—ie, older trans men used cross-sex hormones less often, whereas the recommendation states that there is no reason for older trans men to stop or decrease use of cross-sex hormones. The reason behind this finding cannot be determined with CBS data and deserves further investigation.
Conclusion: This study showed that nationwide registry data can be used for evaluation of CPG implementation.