How Can HCPs Navigate Challenges in Optimizing Medications for Diverse Groups?
More Programs and Publications Featuring Dr. Dana Powell Baker
In this program:
How can optimization of medications for diverse groups be aided by HCPs? Laboratory medicine scientists Dr. Brandy Gunsolus and Dr. Dana Powell Baker discuss the challenges and solutions.
Transcript
Interviewer:
Dr. Gunsolus, what challenges arise in the clinical interpretation of laboratory tests for drug metabolism enzymes in racially and ethnically diverse patient populations? And how can healthcare providers navigate such challenges to optimize medication therapy?
Dr. Brandy Gunsolus:
So probably the biggest challenge is outdated information. A lot of providers, they learned what was being published when these types of tests first came on the market. And they were first told that there was racial differences and there was ethnic differences. And since then, we've determined that, well, that's not really true. But unfortunately, a lot of things that you learn when you first are introduced to a topic, that's what kind of sticks with you. So re-educating our clinicians is probably the most challenging aspect of it. The next challenge is just the testing itself. The testing has changed through the years. It used to be just looking for a couple of mutations here and there. And now, we actually sequence the entire gene. And so we're finding even more alterations within those genes that are more than just a, "You're a high metabolizer, you're a low metabolizer." Well, now there are many subtle levels within that. And so we've learned a lot more as the technology has improved. And unfortunately, a lot of physicians just have not been able to keep up with that technology, especially our primary care physicians. And I don't blame them. Everything in medicine is advancing at light speed.
And it's very difficult, especially for a primary care provider, to keep up with all the advancements in pharmacy and all the advancements in laboratory and in all diagnostics plus treatment options, all the different treatments. It's very difficult, because the information is just coming at them at light speed now. So I don't blame them at all. What they can do, though, is that every laboratory that offers this testing, whether it's an academic medical center or a big commercial reference laboratory, they offer physicians, genetic counselors, geneticists that will help guide them through interpreting these test results and how that specific test result applies to their specific patient. And I strongly encourage clinicians, especially if they do not order these tests on a very routine basis, to please connect with those geneticists and pathologists, PhD chemists, that are at these institutions performing those tests to aid in interpreting those test results with that specific patient.
Interviewer:
That's very important. Dr. Baker, anything to add?
Dr. Dana Powell Baker:
Well, just as I was listening, really, I know I said no, but I guess yes, as I'm adding to it. [chuckle] But as I was listening in, I just couldn't help but to think about just the opportunity to really leverage in a professional collaborative practice. I think that also kind of speaks to our, I would say, kind of like our old school of training, where we learned and tend to work in a silo, whereas now we're trying to work toward breaking down silos and really have effective communication across professions. And so, where we may recognize a gap in our understanding or in our even recent knowledge regarding a specific topic, whether it is drug metabolism enzymes or anything else in that nature, to bring in those other practitioners, to bring in those other specialists. I know any time I may have a question, especially if it might be drug metabolism-related, I always refer to my PharmDs. I'm always quick to give them a call just to get their perspective from their professional lens, or from their scope of practice, so that way I can use that information to help inform my thinking and my understanding.
So I think about that, but I also think about just our workforce and our healthcare providers and ensuring that we have diversity in that pipeline. And so what are we doing in terms of recruitment, retention, training, making sure that our healthcare providers or the workforce collectively represent the diverse patient populations that we're serving, because that increased diversity will also contribute to our understanding and the challenges as we are navigating this together regarding laboratory tests for drug metabolism enzyme, as well as a host of other laboratory tests when we still, just thinking about this conversation on race correction in laboratory medicine. So I'm always thinking of both ends, that recruitment end, but also where are those opportunities to collaborate with other professionals.
Interviewer:
I think not just speaking on enzymes, but just general labs that say PCP may not understand in general. I feel like a lot of the time they'll send a patient to a specialist, but I don't know, there's always a disconnect after that, it seems to be. And the pieces don't always come together, even after going to a specialist for interpreting that said lab values.
Dr. Dana Powell Baker:
Right. And we also have to consider, is every patient going to do that follow-up of going to their specialist? Because if it didn't seem alarming or concerning with their PCP and how life may happen, they may not have the time or the opportunity to follow through with that follow-up with a specialist.
Interviewer:
Right, so it's the provider’s responsibility, really?
Dr. Dana Powell Baker:
Right.
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