LGBTQ Primary Care

A Guide for Primary Care Clinics to Improve Services for Sexual and Gender Minority (SGM) Patients


Sexual and gender minority (SGM) people, referring here to people who are lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ), often experience significant disparities in health care and barriers to service access that can lead to health complications. Primary care services can play an important role in improving health outcomes and reducing mortality. This toolkit provides clinics with guidance and resources to implement recommendations that are likely to improve services for SGM people and individuals who are intersex or have differences of sex development.

Developed with support from the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R21MD011648, the toolkit was produced by staff at the Pacific Institute for Research and Evaluation (PIRE) with assistance from our collaborators at the University of New Mexico, University of Pittsburgh Medical Center, Transgender Resource Center of New Mexico, New Mexico Community AIDS Partnership, and New Mexico Primary Care Association, and a Scientific Advisory Board comprised of SGM patients and patient advocates, direct service providers, and researchers. The content of this toolkit is informed by a systematic literature review, qualitative interviews and focus groups with direct service providers and SGM patients, prioritization processes using the Nominal Group Technique, and feedback from the Scientific Advisory Board. We thank everyone for their contributions to this toolkit.

The toolkit and its content are solely the developers’ responsibility and do not necessarily represent the official views of the National Institutes of Health. Links to external websites and guidelines are provided as a courtesy. However, they are neither a guarantee nor an endorsement by the toolkit developers of the guidelines, products, or services offered on these websites.

Citation: Willging C., Sturm R., Sklar M., Kano M., Davies S., & Eckstrand K. (2021) LGBTQ primary care toolkit: A guide for primary care clinics to improve services for sexual and gender minority (SGM) patients. Albuquerque, NM: Pacific Institute for Research and Evaluation.


This toolkit offers insight into the major health and healthcare disparities impacting the diverse members of the SGM population. The toolkit also provides a model for clinic-led organizational change. This model consists of a structured and staged approach for developing a multi-disciplinary Implementation Team to guide organizational change, establish and align leadership roles, conduct organizational assessments, and use Action Plans to make and monitor progress. Readers will find that this model is not only applicable to organizational change related to primary care for SGM patients but is also relevant to other quality improvements in clinics.

There are nine chapters included in this toolkit. The key points and content of each chapter are described briefly on that chapter’s main page. Although the chapters are intended to build on each other, they may be reviewed as standalone documents. Each chapter also feature tables, sample items, and templates that can help remove some of the guesswork involved in organizational change. In many chapters, we refer readers to the appendices, which contain additional resources—including fillable planning templates—for jumpstarting and keeping track of the change process.

Our goal is to help you create a welcoming and inclusive clinic environment. Simple changes to practices, policies and staff training can dramatically improve the experiences of SGM patients, resulting in the care they deserve. We welcome your feedback on how to improve upon this toolkit. For questions or comments, please use our contact page.