title: Pharmacogenomics in diverse practice settings: implementation beyond major metropolitan areas.
abstract: OBJECTIVE
  The limited formal study of the clinical feasibility of implementing pharmacogenomic tests has thus far focused on providers at large medical centers in urban areas. Our research focuses on small metropolitan, rural and tribal practice settings.
  
  
  METHODS
  We interviewed 17 healthcare providers in western Montana regarding pharmacogenomic testing.
  
  
  RESULTS
  Participants were optimistic about the potential of pharmacogenomic tests, but noted unique barriers in small and rural settings including cost, adherence, patient acceptability and testing timeframe. Participants in tribal settings identified heightened sensitivity to genetics and need for community leadership approval as additional considerations.
  
  
  CONCLUSIONS
  Implementation differences in small metropolitan, rural and tribal communities may affect pharmacogenomic test adoption and utilization, potentially impacting many patients. Original submitted 3 September 2014; Revision submitted 3 December 2014.
authors.affiliation: Institute for Public Health Genetics, University of Washington, Seattle, WA, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Dorfman
authors.forename: Susan
authors.initials: S
authors.lastname: Brown Trinidad
authors.forename: Chelsea T
authors.initials: CT
authors.lastname: Morales
authors.forename: Kevin
authors.initials: K
authors.lastname: Howlett
authors.forename: Wylie
authors.initials: W
authors.lastname: Burke
authors.forename: Erica L
authors.initials: EL
authors.lastname: Woodahl
mesh_terms: D000328:Adult; D005260:Female; D006303:Health Services, Indigenous; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009009:Montana; D010597:Pharmacogenetics / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends; D057285:Precision Medicine; D019035:Rural Health Services
keywords: Alaska Native; American Indian; implementation; indigenous populations; pharmacogenetics; pharmacogenomics; rural