TABLE 4.

Potential barriers to pharmacogenetic implementation for underrepresented populations.

Confederated Salish and Kootenai Tribes (CSKT)	Partnership Health Center (PHC)	Shodair Children’s Hospital (Shodair)
“Some people feel that [genetics] is a potentially sensitive area, that maybe either people who shouldn’t have access to that information might get access to that information or that people who are ‘qualified researchers’ may nonetheless ask research questions that are offensive to certain communities.”—CSKT04, Pharmacist	“To our patient population, cost is always an important thing, so we have a tendency not to run tests unless they’re going to be meaningful and make a difference in care. We don’t want to be doing tests that are unnecessary or tests that have so many limitations that they’re not useful.”—PHC02, Physician/Administrator	“That’s probably one reason why I haven’t used [pharmacogenetics] is because I don’t feel like I could—as a family nurse practitioner, I didn’t get specific training on it, so if I didn’t precept or have somebody to work with who understood it well, there’s no reason for me to order it.”—Shodair06, Nurse Practitioner
“I think working primarily with a native population and recognizing some of the research that has already been done, and I know first-hand that some of those genetic indicators are more represented in [the] Caucasian population so then the benefit of that technology has been to that larger [European] population.”—CSKT02, Physician	“For a lot of people whose clinical life is already so complicated and hard and time-consuming, it’s really stressful to think about adding something new, so I think just being really thoughtful about integrating it in a way that is going to seem palatable to that spectrum. […] Sometimes, it’s just like, ‘I can’t deal with this other new thing’.”—PHCO3, Physician	“One thing I have heard our physicians complain about is the time it takes for results … especially on the acute units. If the kids are there for 7 days, if it takes a week to get [test result] back … they’re gone. It’s pointless.”—Shodair01, Informatics
		“One of the things is I would want to make sure that [pharmacogenetics is] available for all patients. Whenever we’re making decisions, treatment decisions based on insurance, that doesn’t feel good.”—Shodair03, Physician