Open AccessPatients with geographic barriers to health care access are prescribed a higher proportion of drugs with pharmacogenetic testing guidelines
Author(s) -
Dalton Rachel,
Brown Joshua D.,
Duarte Julio D.
Publication year - 2021
Publication title -
clinical and translational science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.303
H-Index - 44
eISSN - 1752-8062
pISSN - 1752-8054
DOI - 10.1111/cts.13032
Subject(s) - medicine , guideline , quartile , confidence interval , socioeconomic status , rate ratio , demography , pharmacogenetics , medline , health care , incidence (geometry) , geographic variation , family medicine , environmental health , population , biochemistry , chemistry , physics , optics , pathology , sociology , political science , genotype , law , economics , gene , economic growth
Pharmacogenetic (PGx) testing may be particularly beneficial in medically underserved populations by reducing the number of appointments required to optimize drug therapy and increasing the effectiveness of less expensive off‐patent drugs. The objective of this study was to identify patient populations with poor health care access and assess prescribing trends for drugs with published PGx testing guidelines. We used electronic health record data from 67,753 University of Florida Health patients, geographic access scores calculated via the 2‐step floating catchment area method, and a composite measure of socioeconomic status. Comparing the poorest (Q4) and greatest (Q1) access score quartiles, poor geographic access was significantly associated with fewer prescriber encounters (incidence rate ratio [IRR] 0.88, 95% confidence interval [CI] 0.86–0.91), fewer total unique drugs (IRR 0.92, 95% CI 0.9–0.95), and fewer PGx guideline drugs (IRR 0.94, 95% CI 0.9–0.99). After correcting for number of unique drugs, patients in low‐access areas were prescribed a greater proportion of PGx guideline drugs (IRR 1.08, 95% CI 1.04–1.13). We detected significant interactions between Black race and access score. Compared to Q1, Black patients with Q4 access scores were disproportionately affected and had fewer encounters (IRR 0.76, 95% CI 0.7–0.82) and a higher proportion of PGx drugs (IRR 1.26, 95% CI 1.13–1.41), creating further disparity. Overall, these results suggest that improved geographic access to PGx testing may allow prescribers to make more efficient use of limited opportunities to optimize therapy for drugs with PGx testing guidelines.