Health equity in the implementation of genomics and precision medicine: A public health imperative

Khoury, Muin J.; Bowen, Scott; Dotson, W. David; Drzymalla, Emily; Green, Ridgely F; Goldstein, Robert B.; Kolor, Katherine; Liburd, Leandris; Sperling, Laurence; Bunnell, Rebecca

doi:10.1016/j.gim.2022.04.009

Cited by 77 publications

(45 citation statements)

References 61 publications

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“…Reaching and educating the pharmacists and other healthcare clinicians working with these underserved populations is critical to avoid worsening of existing health disparities. Khoury et al (2022) recently described the need for a public health approach to health equity in genomics and precision medicine, and much of the same can be said of PGx.…”

Section: Discussionmentioning

confidence: 99%

Addressing disparities in pharmacogenomics through rural and underserved workforce education

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 99%

Addressing disparities in pharmacogenomics through rural and underserved workforce education

et al. 2023

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“…This has direct implications for the field of precision medicine in that groups less likely to receive precision medicine treatments are racial minority and ethnic groups, medically underserved urban and rural communities, uninsured and underinsured, as well as those with lower education and income ( 11 ). More so, while precision medicine commonly uses genomic data for patient treatment plans, genome-wide association studies (GWAS) rarely test the relationship between complex genetic traits and environmental exposure ( 8 ).…”

Section: The Promises and Challenges Of Precision Medicinementioning

confidence: 99%

Health equity innovation in precision medicine: Current challenges and future directions

Ory

Adepoju²,

Ramos³

et al. 2023

Front. Public Health

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“…Should these technologies see increased adoption into routine clinical use, they are likely to change multiple aspects of care including pathways of care, health and human resources, health care infrastructure, patient outcomes and experiences, and raise equity considerations. 4,[11][12][13] To alert decision-makers to innovations within precision medicine and possible implications for health systems, the 2023 Watch List identifies new and emerging precision medicine technologies and crosscutting issues related to the technologies that are likely to have a significant impact on health care systems in Canada over the next 5 years.…”

Section: The Promise Of Precision Medicinementioning

confidence: 99%

“…In many health systems, there are disparities in who can access and use existing precision medicine technologies. 13,81 These disparities can result from a reduced ability to access health care because of costs, availability, geography, and awareness. 13,81 They are also exacerbated by systemic racism in health care, which excludes and makes health care inaccessible to racialized people and Indigenous Peoples.…”

Section: Top Issues About Precision Medicine Technologies To Watch In...mentioning

confidence: 99%

“…13,81 These disparities can result from a reduced ability to access health care because of costs, availability, geography, and awareness. 13,81 They are also exacerbated by systemic racism in health care, which excludes and makes health care inaccessible to racialized people and Indigenous Peoples. Moreover, some populations have historically not been included in health research or the databases used to develop precision medicine technologies.…”

Section: Top Issues About Precision Medicine Technologies To Watch In...mentioning

confidence: 99%

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2023 Watch List: Top 10 Precision Medicine Technologies and Issues

Basharat¹,

Smith²,

Darvesh³

et al. 2023

cjht

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CADTH’s 2023 Watch List presents the top 10 precision medicine technologies and issues that have the potential to make a significant and meaningful impact in transforming health systems in Canada over the next 5 years. These technologies and issues are likely to shape the future of health care. The Human Genome Project was completed 20 years ago and offers new opportunities to use an individual's genetic information to manage their health care. Today, as health systems see an emergence of new precision medicine technologies that can use a person’s unique characteristics to inform and tailor their care, the 2023 Watch List unpacks the hype from hope, and indicates where there is likely real opportunity to improve patient care and health systems delivery. As part of the 2023 Watch List, we identify and describe the 5 top precision medicine technologies; among them, examples such as liquid biopsies for informing cancer treatments and pharmacogenomics testing for mental health conditions that may shape the future of health care. To prepare health systems for their wider adoption and implementation, the 2023 Watch List explores some considerations for health care decision-makers about the impact and implications the technologies may have on care pathways, health human resources, health care infrastructure, and health equity. The 2023 Watch List also identifies the top 5 issues that crosscut the broader scope of precision medicine technologies and could limit health systems from realizing the full potential of the technologies. Among them, issues such as increasing complexity related to interpreting test results and challenges in regulating precision medicine technologies are key issues that likely warrant more attention and will influence the wider adoption, diffusion, and implementation of precision medicine technologies. Collectively, monitoring ongoing developments and evidence related to the top technologies and issues highlighted in the 2023 Watch List can help support health care stakeholders to future-proof health systems and guide health system planning in Canada.

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Health equity in the implementation of genomics and precision medicine: A public health imperative

Cited by 77 publications

References 61 publications

Addressing disparities in pharmacogenomics through rural and underserved workforce education

Addressing disparities in pharmacogenomics through rural and underserved workforce education

Health equity innovation in precision medicine: Current challenges and future directions

2023 Watch List: Top 10 Precision Medicine Technologies and Issues

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