Addressing disparities in pharmacogenomics through rural and underserved workforce education

Abstract

Introduction: While pharmacogenomic (PGx) testing is routine in urban healthcare institutions or academic health centers with access to existing expertise, uptake in medically-underserved areas is lagging. The primary objective of this workforce education program is to extend access to didactic, case-based and clinical PGx training for pharmacists serving rural Minnesota and populations experiencing health disparities in Minnesota.Methods: A PGx workforce training program funded through the Minnesota Department of Health was offered through the University of Minnesota College of Pharmacy (COP) to pharmacists working in rural and/or underserved areas in the state of Minnesota. Learning activities included a 16-week, asynchronous PGx didactic course covering PGx topics, a 15-min recorded presentation, an in-person PGx case-based workshop, and a live international PGx Conference hosted by the University of Minnesota COP and attendance at our PGx Extension of Community Health Outcomes (ECHO).Results: Twenty-nine pharmacists applied for the initial year of the program, with 12 (41%) being accepted. Four (33%) practiced in a hospital setting, four (33%) in retail pharmacy, two (17%) in managed care, and two (17%) in other areas. The majority had not implemented a PGx program as part of their practice, although nearly all responded definitely or probably yes when asked if they expected their organization to increase its use of PGx testing services over the next three years. All participants either strongly or somewhat agreed that this program helped them identify how and where to access clinical PGx guidelines and literature and improved their ability to read and interpret PGx test results. Eight participants (67%) strongly or somewhat agreed that they expected to increase the number of PGx consultations in their practice, while ten (83%) strongly or somewhat agreed they would be able to apply what they learned in this program to their practice in the next six months to a year.Discussion: This novel PGx training program focused exclusively on pharmacists in rural and/or underserved areas with a delivery method that could be accomplished conveniently and remotely. Although most participants’ organizations had yet to implement PGx testing routinely, most anticipated this to change in the next few years.

Healthcare professionals' and consumers' knowledge, attitudes, perspectives, and education needs in oncology pharmacogenomics: A systematic review

“…47 It is worth noting that a lack of access to PGx testing is also a known issue in high income countries, as several studies in the United States have reported that rural populations have limited access to PGx testing and PGx-trained HCPs compared to people residing in metropolitan areas, due to the fact that most PGx services have been limited to larger institutions. 48,49 In the study conducted by Nagy et al in Egypt, they reported cultural or religious beliefs as a barrier to adoption of PGx in oncology practice, which was not identified in the other studies included in this review; however, this barrier was not further explained by the authors. These findings highlight that a unique set of challenges exist in different regions, and further studies outside of the United States, particularly in emergent nations and within different health system constructs, are required to better understand patients and practitioners' viewpoints and education needs in oncology PGx relevant to the local context.…”

“…47 It is worth noting that a lack of access to PGx testing is also a known issue in high income countries, as several studies in the United States have reported that rural populations have limited access to PGx testing and PGx‐trained HCPs compared to people residing in metropolitan areas, due to the fact that most PGx services have been limited to larger institutions. 48 , 49 In the study conducted by Nagy et al. in Egypt, they reported cultural or religious beliefs as a barrier to adoption of PGx in oncology practice, which was not identified in the other studies included in this review; however, this barrier was not further explained by the authors.…”

“…Resource constraints, such as lack of trained staff and testing facilities, unfortunately impede the implementation of PGx in Egypt specifically, a lower‐middle income country, which were not reported in the remaining 22 studies conducted in high‐income countries as defined by the World Bank 47 . It is worth noting that a lack of access to PGx testing is also a known issue in high income countries, as several studies in the United States have reported that rural populations have limited access to PGx testing and PGx‐trained HCPs compared to people residing in metropolitan areas, due to the fact that most PGx services have been limited to larger institutions 48,49 . In the study conducted by Nagy et al.…”

ACCESS: an empirically-based framework developed by the International Nursing CASCADE Consortium to address genomic disparities through the nursing workforce

“…The universal shortage of genomic specialists requires that healthcare providers and policymakers seek for novel and sustainable solutions regarding widespread implementation of germline testing. This is in addition to the need for streamlining educational efforts regarding implications of genetic testing, especially for prevention and targeted therapeutics ( Al-Sukhun et al, 2023 ; Brown et al, 2023 ; Moyo et al, 2023 ). Implementation of a systematic guide like the ACCESS framework, and partnering with the nursing workforce who is a major stakeholder in promoting health equity, may facilitate initiatives such as the Rare Genomes Project (RGP) ( Serrano et al, 2023 ) and the Genomic Answers for Kids (GA4K) ( Kane et al, 2023 ) reduce barriers and inequalities for underrepresented patients with rare genomic disorders and for children, respectively.…”

The Critical Role of Pharmacists in the Clinical Delivery of Pharmacogenetics in the U.S

“…Furthermore, continued efforts are needed to develop effective learning curricula and practice experiences to insure pharmacists possess the skills and knowledge to integrate PGx into practice [149][150][151]. For pharmacists in advanced training [152] as well as practicing pharmacists, a number of novel approaches have been developed, including experiential learning, online learning, clinical decision support and patient educational materials, and networks of PGx experts [78,[153][154][155][156][157]. In particular, several schools and professional organizations have developed participatory or experiential learning opportunities for PGx testing [158][159][160][161].…”