Ensuring equity: Pharmacogenetic implementation in rural and tribal communities

Area of Science:

• Pharmacogenomics and Implementation Science
• Health Services Research
• Health Equity

Background:

• Pharmacogenetic testing implementation is concentrated in major health systems, risking increased healthcare disparities for rural and tribal populations.
• Montana's demographics, with a large rural and tribal population, highlight the need for accessible pharmacogenetic testing strategies.

Purpose of the Study:

• To explore novel strategies for broadening pharmacogenetic testing accessibility in underserved populations within Montana.
• To assess the utility of a centralized, telehealth-delivered pharmacogenetic service for rural and tribal communities.

Main Methods:

• Partnerships formed between the University of Montana and three early adopter sites serving neglected populations.
• Conducted 45 semi-structured interviews with key stakeholders to gather feedback on a centralized pharmacogenetic service via telehealth.
• Explored challenges including infrastructure, funding, personnel, ethical considerations for biospecimen collection, and financial barriers.

Main Results:

• Rural and tribal healthcare settings face significant infrastructure, personnel, and funding limitations for pharmacogenetic services.
• Tribal communities emphasized the need for ethical genetic research practices due to historical trauma.
• Stakeholders identified telehealth as crucial for connecting providers and patients to expertise, improving therapeutic benefit, reducing side effects, and enhancing adherence.

Conclusions:

• Telehealth-based centralized pharmacogenetic services can improve access for neglected populations and reduce healthcare inequities.
• Addressing financial barriers and ethical considerations is vital for equitable pharmacogenetic testing implementation.
• This study provides a framework for resource-limited settings to implement pharmacogenetic testing equitably.