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Ensuring equity: Pharmacogenetic implementation in rural and tribal communities

Implementation strategies for pharmacogenetic testing have been largely limited to major academic medical centers and large health systems, threatening to exacerbate healthcare disparities for rural and tribal populations. There exists a need in Montana (United States)—a state where two-thirds of th...

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Autores principales: Leitch, Tianna M., Killam, Shayna R., Brown, Karen E., Katseanes, Kirk C., George, Kathleen M., Schwanke, Corbin, Loveland, Joshua, Elias, Abdallah F., Haney, Kerry, Krebsbach, Kate, Muzquiz, LeeAnna I., Trinidad, Susan B., Woodahl, Erica L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514788/
https://www.ncbi.nlm.nih.gov/pubmed/36176435
http://dx.doi.org/10.3389/fphar.2022.953142
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author Leitch, Tianna M.
Killam, Shayna R.
Brown, Karen E.
Katseanes, Kirk C.
George, Kathleen M.
Schwanke, Corbin
Loveland, Joshua
Elias, Abdallah F.
Haney, Kerry
Krebsbach, Kate
Muzquiz, LeeAnna I.
Trinidad, Susan B.
Woodahl, Erica L.
author_facet Leitch, Tianna M.
Killam, Shayna R.
Brown, Karen E.
Katseanes, Kirk C.
George, Kathleen M.
Schwanke, Corbin
Loveland, Joshua
Elias, Abdallah F.
Haney, Kerry
Krebsbach, Kate
Muzquiz, LeeAnna I.
Trinidad, Susan B.
Woodahl, Erica L.
author_sort Leitch, Tianna M.
collection PubMed
description Implementation strategies for pharmacogenetic testing have been largely limited to major academic medical centers and large health systems, threatening to exacerbate healthcare disparities for rural and tribal populations. There exists a need in Montana (United States)—a state where two-thirds of the population live in rural areas and with a large proportion of tribal residents—to develop novel strategies to make pharmacogenetic testing more broadly available. We established partnerships between University of Montana (UM) and three early adopter sites providing patient-centered care to historically neglected populations. We conducted 45 semi-structured interviews with key stakeholders at each site and solicited participant feedback on the utility of a centralized pharmacogenetic service at UM offering consultations to patients and providers statewide via telehealth. For settings serving rural patients—tribal and non-tribal—participants described healthcare facilities without adequate infrastructure, personnel, and funding to implement pharmacogenetic services. Participants serving tribal communities stressed the need for ethical practices for collecting biospecimens and returning genetic results to patients, largely due to historical and contemporary traumas experienced by tribal populations with regard to genetic research. Participants expressed that pharmacogenetic testing could benefit patients by achieving therapeutic benefit sooner, reducing the risk of side effects, and improving adherence outcomes for patients with limited access to follow-up services in remote areas. Others expressed concern that financial barriers to pharmacogenetic testing for patients of lower socioeconomic status would further exacerbate inequities in care. Participants valued the role of telehealth to deliver pharmacogenetic consults from a centralized service at UM, describing the ability to connect providers and patients to resources and expertise as imperative to driving successful pharmacogenetic implementation. Our results support strategies to improve access to pharmacogenetic testing for neglected patient populations and create opportunities to reduce existing healthcare inequities. By exploring critical challenges for pharmacogenetic implementation focused on serving underserved communities, this work can help guide equitable frameworks to serve as a model for other resource-limited settings looking to initiate pharmacogenetic testing.
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spelling pubmed-95147882022-09-28 Ensuring equity: Pharmacogenetic implementation in rural and tribal communities Leitch, Tianna M. Killam, Shayna R. Brown, Karen E. Katseanes, Kirk C. George, Kathleen M. Schwanke, Corbin Loveland, Joshua Elias, Abdallah F. Haney, Kerry Krebsbach, Kate Muzquiz, LeeAnna I. Trinidad, Susan B. Woodahl, Erica L. Front Pharmacol Pharmacology Implementation strategies for pharmacogenetic testing have been largely limited to major academic medical centers and large health systems, threatening to exacerbate healthcare disparities for rural and tribal populations. There exists a need in Montana (United States)—a state where two-thirds of the population live in rural areas and with a large proportion of tribal residents—to develop novel strategies to make pharmacogenetic testing more broadly available. We established partnerships between University of Montana (UM) and three early adopter sites providing patient-centered care to historically neglected populations. We conducted 45 semi-structured interviews with key stakeholders at each site and solicited participant feedback on the utility of a centralized pharmacogenetic service at UM offering consultations to patients and providers statewide via telehealth. For settings serving rural patients—tribal and non-tribal—participants described healthcare facilities without adequate infrastructure, personnel, and funding to implement pharmacogenetic services. Participants serving tribal communities stressed the need for ethical practices for collecting biospecimens and returning genetic results to patients, largely due to historical and contemporary traumas experienced by tribal populations with regard to genetic research. Participants expressed that pharmacogenetic testing could benefit patients by achieving therapeutic benefit sooner, reducing the risk of side effects, and improving adherence outcomes for patients with limited access to follow-up services in remote areas. Others expressed concern that financial barriers to pharmacogenetic testing for patients of lower socioeconomic status would further exacerbate inequities in care. Participants valued the role of telehealth to deliver pharmacogenetic consults from a centralized service at UM, describing the ability to connect providers and patients to resources and expertise as imperative to driving successful pharmacogenetic implementation. Our results support strategies to improve access to pharmacogenetic testing for neglected patient populations and create opportunities to reduce existing healthcare inequities. By exploring critical challenges for pharmacogenetic implementation focused on serving underserved communities, this work can help guide equitable frameworks to serve as a model for other resource-limited settings looking to initiate pharmacogenetic testing. Frontiers Media S.A. 2022-09-13 /pmc/articles/PMC9514788/ /pubmed/36176435 http://dx.doi.org/10.3389/fphar.2022.953142 Text en Copyright © 2022 Leitch, Killam, Brown, Katseanes, George, Schwanke, Loveland, Elias, Haney, Krebsbach, Muzquiz, Trinidad and Woodahl. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Leitch, Tianna M.
Killam, Shayna R.
Brown, Karen E.
Katseanes, Kirk C.
George, Kathleen M.
Schwanke, Corbin
Loveland, Joshua
Elias, Abdallah F.
Haney, Kerry
Krebsbach, Kate
Muzquiz, LeeAnna I.
Trinidad, Susan B.
Woodahl, Erica L.
Ensuring equity: Pharmacogenetic implementation in rural and tribal communities
title Ensuring equity: Pharmacogenetic implementation in rural and tribal communities
title_full Ensuring equity: Pharmacogenetic implementation in rural and tribal communities
title_fullStr Ensuring equity: Pharmacogenetic implementation in rural and tribal communities
title_full_unstemmed Ensuring equity: Pharmacogenetic implementation in rural and tribal communities
title_short Ensuring equity: Pharmacogenetic implementation in rural and tribal communities
title_sort ensuring equity: pharmacogenetic implementation in rural and tribal communities
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514788/
https://www.ncbi.nlm.nih.gov/pubmed/36176435
http://dx.doi.org/10.3389/fphar.2022.953142
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