Examination of differences between actual and potential revenue generation in a pharmacist-run ambulatory clinic.

BACKGROUND: Pharmacists are not billable healthcare providers under Medicare Part B or most insurance plans. Because of this, pharmacist services are relegated to incident-to-provider billing, despite pharmacists routinely providing services high in complexity. This discrepancy may negatively skew perceptions of pharmacists' contributions to outpatient clinic care. OBJECTIVES: The objective of this study was to identify the potential revenue generation for pharmacist-delivered services at a single, rural South Dakota clinic if pharmacists were considered billable healthcare providers. METHODS: This retrospective, single center study utilized a chart review of first-quarter data from a single ambulatory clinic served by a 0.5 full time equivalent pharmacist serving Chronic Disease Management (CDM) and COVID-19 patients. For each appointment, the chart note was reviewed for elements that would satisfy requirements for Current Procedural Terminology (CPT®) billing codes. Medicare and Medicaid reimbursement was determined using official 2022 Physician Fee Schedules and private insurance reimbursement was set at a single rate of 60% of the fee schedule of the most common private payer. RESULTS: During the three-month study period, 118 patients (206 appointments) were seen by the pharmacist. The amount paid to the clinic was estimated at $2,174.91. The hypothetical amount paid to the clinic if pharmacists were considered billable healthcare providers is $10,415.31 for CDM clinic and $7,953.48 for COVID-19 clinic, totaling $18,368.79. Excluding uninsured patients, the hypothetical total is $17,102.03, with a total unrealized revenue of $16,193.88. CONCLUSION: If pharmacists were considered billable healthcare providers and their services were billed accordingly, the potential revenue generation is significantly higher than actually generated revenue. This estimated data can be used to better quantify and qualify appointment-related data for non-pharmacist clinic managers.

Battling professional self-sabotage: Embracing standard of care as the future of pharmacy regulation.

Laws and regulations are intended to protect the public; however, overregulation of the profession can block initiatives focused on patient safety and public health. This article discusses the 3 main regulatory approaches to pharmacy practice: standard of care (SOC), bright line, and right touch. An SOC regulatory model supports practitioners delivering patient care within their scope of practice and clinical training. Patient safety is maintained by measuring care against other practitioners within the same practice setting while supporting practitioners practicing at the top of their clinical ability. Compared with bright line and right touch approaches, the SOC regulatory model provides the adaptability needed to respond to different practice scenarios and settings, thus increasing access to health care and opportunities for innovation. To have a lasting impact on the profession and support patients, all pharmacy professionals must be fluent in regulatory approaches and advocate for states to transition to SOC regulatory models.

Developing sustainable workflows for community pharmacy-based SARS-CoV-2 testing.

BACKGROUND: The coronavirus disease Rapid Antigen Testing Expansion Program (Program) employed a drive-thru model to maximize pharmacy staff and the public's safety. OBJECTIVES: To quickly design, implement, and disseminate a pharmacy-based point-of-care testing program during a public health crisis. PRACTICE DESCRIPTION: Community pharmacies in Idaho were engaged in the state's public health efforts to boost severe acute respiratory syndrome coronavirus 2 testing statewide. Geographic location was a major recruitment factor. Two recruitment periods were held to extend the Program's reach into more remote underserved communities. PRACTICE INNOVATION: Program and pharmacy staff developed workflows and materials in an iterative process. Pharmacies received testing supplies. Program staff created e-Care plans for documentation and reimbursement and designed a Web portal for state reporting of positive rapid antigen test results. EVALUATION METHODS: Testing data (pharmacy location, patient insurance status, test type and results, number of submitted Medicaid claims) were captured in an online form. RESULTS: From September to December 2020, 13 pharmacies opted into a drive-thru, rapid antigen point-of-care testing and nasal swab for offsite testing program. A total of 2425 tests were performed. Approximately 29.4% of point-of-care tests were positive, and 70.6% required backup polymerase chain reaction confirmatory analysis. Patient insurance breakdown was 72.1% private, 8% Medicare, 11.4% Medicaid, and 8.5% uninsured. On average, pharmacies tested patients an average of 2.3 hours/day and 2.6 days/week. As a group, they provided 77.5 hours of testing per week statewide. Program pharmacies accounted for an average of 5.1% of testing across the entire state at the end of December 2020. CONCLUSION: Independent community-based pharmacies should be considered as partners in public health initiatives.

Assessing Pharmacists' Views and Barriers to Providing and Billing for Pharmacist-Provided Health Care Services.

Background: The role of Idaho and Alaska pharmacists in providing health care services has steadily broadened over recent years. With many new pharmacist-provided health care service possibilities, this study assessed the impact of these advancements on community pharmacies. Objective: The objective of this study was to identify current pharmacist-provided health care services and pharmacist-perceived barriers to providing and billing for these services in Idaho and Alaska community pharmacies. Methods: A questionnaire was developed focusing on 2 areas: providing services and billing for services. Pharmacy students on experiential rotations administered the questionnaires to pharmacists at their rotation sites. Pharmacists at community pharmacy practice sites in Idaho and Alaska completed the questionnaire in an interview format conducted by students. Likert-type scale data were analyzed using descriptive statistics. Because the study did not include a comparator group, no power calculation was conducted. All open-response answers were analyzed independently by 2 researchers and discrepancies in coding open-ended questions were resolved by discussion with a group of 4 researchers. Results: Most pharmacists reported that they already provide non-dispensing services, desired to implement new services, and had confidence in their team's ability to handle new services. Time and resources were the most cited barriers to providing new services; compensation, company support, and education were the most cited barriers to billing for services. Conclusions: Community pharmacists already provide non-dispensing services and many are looking to provide more services, but barriers of time, resources, compensation, company support, and education will need to be overcome to move forward.

Pharmacist medical provider status in Alaska, the last frontier.

Alaska law and health care policies, incidentally, designate pharmacists as billable medical providers when providing health care services. However, state and commercial provider enrollment and claims processing systems are not configured to enroll and accept claims from pharmacists. Alaska law does not protect pharmacists from unfair discriminatory practices by payors despite such protections being afforded in federal regulation. Additional advocacy and legislation are needed to fully implement pharmacists as billing medical providers within traditional payor models. Health care services provided by pharmacists can help alleviate unmet patient health care needs in the community and primary care settings of Alaska. The identified barriers will continue to limit the ability of pharmacists in Alaska to sustainably provide lifesaving, scope-permitted, and otherwise covered services to those in greatest need.

Implementation of a pharmacogenomics service in a community pharmacy.

OBJECTIVE To determine the feasibility of implementing a pharmacogenomics service in a community pharmacy. SETTING A single community pharmacy that is part of a regional chain known for offering innovative pharmacy services. PRACTICE DESCRIPTION Community pharmacists at the project site routinely provide clinical pharmacy services, including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. PRACTICE INNOVATION The implementation of a pharmacogenomic testing and interpretation service for the liver isoenzyme cytochrome P450 2C19. PARTICIPANTS 18 patients taking clopidogrel, a drug metabolized by CYP2C19. MAIN OUTCOME MEASURES Rate of patient participation, rate of prescriber acceptance of pharmacist recommendation, time to perform genetic testing service, and number of claims submitted to and paid by insurance. RESULTS Of 41 patients taking clopidogrel and meeting project criteria, 18 (43.9%) enrolled and completed testing and interpretation of pharmacogenomic results. The mean time pharmacists spent completing all stages of the project with each participant was 76.6 minutes. The mean time to complete participation in the project (time between person's first and second visit) was 30.1 days. Nine patients had wild-type alleles, and pharmacists recommended continuation of therapy as ordered. Genetic variants were found in the other nine patients, and all pharmacist recommendations for modifications in therapy were ultimately accepted by prescribers. Overall, 17 patients consented to filing of reimbursement claims with their insurers. Five were not able to be billed due to submission difficulties. Of the remaining 12, none was paid. CONCLUSION A pharmacogenomics service can be an extension of medication therapy management services in a community pharmacy. Prescribers are receptive to having community pharmacists conduct pharmacogenomics testing, but reimbursement is a challenge.

Student personality type and preferred rounding methods in an internal medicine advanced pharmacy practice experience.

BACKGROUND: Pharmacy students completing Internal Medicine rotations may be exposed to different stylistic approaches from providers on routine activities like patient rounds. This may be beneficial as students can learn in different ways. Conversely, extensive exposure to approaches that do not suit them may hinder student learning or lead students to feel they don't belong in a clinical setting. EDUCATIONAL ACTIVITY: This study sought to assess how students of different personality types perceived benefits to their learning based on the rounding styles of two providers. One provider (Dr. Bedside) used a team-based, bedside rounding method with direct patient interaction, while the other (Dr. Table) used a tableside team-based discussion for each patient. In the final week of a 5-week Internal Medicine APPE rotation, a cohort of ten students completed a 12-item survey that collected details on two personality assessments and assessed perspectives of the two rounding styles. EVALUATION FINDINGS: Ten students completed the personality assessments and survey. Students represented a diverse set of StrengthsFinder strengths and DOPE personality types, with the highest concentration (60%) of students receiving the Executing strength. All students agreed or strongly agreed that the exposure to two different rounding styles was valuable to their learning, with 80% of students preferring Dr. Bedside's approach. ANALYSIS OF EDUCATIONAL ACTIVITY: Overall, no trends were identified between preference of rounding style and results from personality assessments, which indicates the current approach of exposing students to two rounding styles does not negatively impact certain learners based on DOPE and StrengthsFinders personality types.

Using the Kirkpatrick model to evaluate a sepsis escape room for advanced pharmacy learners.

BACKGROUND AND PURPOSE: The purpose of this study was to use the first three levels of the Kirkpatrick Model to evaluate the effectiveness of a simulation center-based escape room activity designed to positively influence student learning. EDUCATIONAL ACTIVITY AND SETTING: In this simulation, learners solve puzzles related to care of a critically ill patient. This activity was assessed via an assessment questionnaire (Kirkpatrick level 1), a pre/post learner knowledge quiz and learner self-assessment of skills and attitudes (Kirkpatrick level 2), and unstructured observation of learners upon return to the clinical environment (Kirkpatrick level 3). FINDINGS: Average learner knowledge assessment scores (Kirkpatrick level 2) improved from 80% (pre-) to 90.5% (post-) and learners identified an increased confidence in disease state diagnosis and expression of recommendations (Kirkpatrick level 2). Learner perception of the activity (Kirkpatrick level 1) was positive but also included areas for improvement. Anecdotal reporting supports learners transfer of the knowledge and skills reviewed in the session to practice (Kirkpatrick level 3), but no formal data collection or analysis was completed. SUMMARY: This study provides quantitative and qualitative evidence to support effectiveness of the activity according to Kirkpatrick's Levels 1 and 2, and anecdotal evidence to support effectiveness according to Kirkpatrick's Level 3. Learners had positive perspectives of this activity and demonstrated evidence of increased knowledge and self-reported confidence in skills and attitudes, suggesting this activity has a positive impact on learners in the short-term; however, the data is not robust enough to support conclusions that this activity influences learner practice.

Assessment of non-time-intensive changes to a management course to address course evaluation scores.

BACKGROUND: Student-completed course evaluations are often included in university faculty promotion and tenure packets but may not be the best metrics for student learning. This juxtaposition creates a challenge - the metric faculty first want to improve is student learning rather than student perception, but course changes improving student learning do not always result in higher course evaluation scores. Additionally, making course changes can be time consuming for faculty. The objective of this project was to assess the changes made to a course, the time spent making those changes, and the impact of the changes on course evaluation scores and student performance. EDUCATIONAL ACTIVITY: A single course focused on management with a business plan as the primary course project was revised in Fall 2023; the goal of revisions was to address poor course evaluation scores and negative student perceptions of the course in as little faculty time as possible while maintaining quality of student work. Primary changes centered around the business plan project and a shift in course communication. Evaluation of the changes occurred through mid-semester survey and discussion and end-of-semester survey for the 2023 cohort, and comparing course evaluations and student work products between the 2022 and 2023 cohorts. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY: Course evaluation scores were improved and student feedback was more positive for the revised Fall 2023 course. The implemented changes did not negatively affect student performance as quality of the business plan project was maintained across both semesters. Instructor transparency and responsiveness through the mid-semester survey and discussion may have positively influenced course evaluations scores. Overall, the course changes did not take a significant amount of faculty time, but the desired outcome of improving course evaluation scores was recognized.

Words matter: Comments in support of diagnosis education in pharmacy.

Diagnosis education is explicitly included in the Draft Accreditation Standards 2025 and should be wholeheartedly supported. To address the staggering number of diagnostic errors in the US, the National Academy of Medicine advocates for diagnosis education for all health professions. Misperceptions of pharmacists' involvement in diagnosis are exacerbated by use of implicit language and euphemisms, and it's long overdue that we provide clarity. Pharmacists are engaged in diagnosis and diagnostic reasoning in everyday practice whether realized or not. Diagnosis education is implicitly included in US pharmacy curricula in the Pharmacists' Patient Care Process, and it is time to give students the language to engage in it responsibly to be practice-ready in all states. The explicit inclusion of diagnosis in the Draft Standards 2025 has positive implications for education, practice, and graduates.

Community Pharmacy Credentialing for Medical Insurance to Facilitate Sustainability in COVID-19 Testing.

Background: In April 2020, pharmacists were added as medical providers under Idaho Medicaid in response to recent scope expansion for pharmacists and to increase beneficiaries' access to coronavirus disease 2019 (COVID-19) testing and services. The COVID-19 pandemic prompted expedited Medicaid enrollment for pharmacists but did not address coverage of medical services provided to privately insured individuals for pharmacy-based testing services. Objective: This study aimed to describe processes used by independently owned, community-based pharmacies in Idaho to credential with private insurers and report outcomes. Methods: Relevant information and forms required to credential with the four major payers in the state of Idaho were collected. Packets were obtained via medical insurers' websites and by direct contact. Questions that arose from community pharmacists during the submission process were collected and answered on a shared spreadsheet, and insurance representatives were contacted directly to resolve questions. Results: Eight out of 13 participating pharmacies submitted an average of three credentialing packets for their facilities. Thirty-five pharmacists also submitted an average of four credentialing packets for themselves. As of mid-May 2021, nearly 20 weeks after submission, only 67 out of 129 pharmacists had received word regarding the status of their applications. Less than half of all pharmacist applications were approved (after their first attempt). Conclusion: Efforts to support the education of both pharmacists and medical insurers may streamline the credentialing processes in the future.

Making pharmacogenetic testing a reality in a community pharmacy.

OBJECTIVE: To provide information for community pharmacies considering implementation of a pharmacogenetic testing service. SETTING: A single community pharmacy from a regional chain. PRACTICE DESCRIPTION: Community pharmacists at the study site routinely provide pharmacy services including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. The pharmacy is a training site for post-graduate year 1 and 2 community-pharmacy residents and for introductory and advanced pharmacy practice experience students. PRACTICE INNOVATION: Implementation of a pharmacogenetics testing service in a community pharmacy. MAIN OUTCOME MEASURES: Feasibility of offering a pharmacogenetics testing service in a community pharmacy. RESULTS: Study investigators identified several internal and external barriers to the community pharmacy when initiating a pharmacogenetics service. This article shares experiences of the study team and solutions to the identified barriers. CONCLUSION: Community pharmacies interested in providing pharmacogenetic testing can overcome barriers by identifying practice partners and planning appropriately.

Pharmacist Impact on Immunization Rates in Asplenic Patients.

Background: Asplenic patients can present unique challenges when updating immunizations. Pharmacists have proven to have a positive impact on immunization rates in asplenic patients. Objectives: To determine the impact of pharmacist intervention on the up-to-date immunization status in asplenic patients in a single rural family medicine clinic and identify quality improvement opportunities for the immunization service. Service Description: The pharmacist obtained an initial list of asplenic patients to create a longitudinal tracking spreadsheet for immunizations that identified missing vaccines for each patient; provider education on vaccine needs in this population and the service was also provided. The ongoing service consists of regular updates to the spreadsheet as patients receive vaccines and a quarterly check of the entire spreadsheet to determine needed vaccines; if needed vaccines are identified, the pharmacist facilitates a patient appointment to obtain the vaccine. Methods: A retrospective chart review was completed in Spring 2022 for all patients included in the baseline report. Patients were categorized based on vaccine status and outstanding vaccines were noted. An evaluation was completed to determine if any identifiable trends across providers were evident based on patient immunization status. Results: A total of 33 asplenic patients were identified at baseline; three (9%) were up-to-date at baseline. Of the 30 patients who were maintained in the clinic, 16 (53.5%) were up-to-date at the point of review. Pharmacist intervention increased the total vaccine completion rate by 44.5% from baseline to follow-up. The biggest improvement for a specific immunization status was made on the meningitis b vaccine; Haemophilus influenzae b showed the highest completion rate at follow-up. No trends were noted across providers that indicated why some providers had patients with higher immunization rates than others. Conclusion: Pharmacist intervention contributed to an increase in immunization rates in a single immunocompromised patient population that requires a specialized immunization schedule.

Redefining 'advanced': Supporting and promoting practice change through community advanced pharmacy practice experiences.

INTRODUCTION: Community pharmacy practice in the United States (US) has faced several external pressures, threatening traditional practice models. Schools and colleges of pharmacy (S/COP), particularly through experiential rotations, are perfectly poised to help these practices create new sustainable business models. The purpose of this article is to highlight demonstrated, reproducible successes of community advanced pharmacy practice experience (APPE) advancement initiatives. PERSPECTIVE: Despite community pharmacists being highly-trained health care providers with roughly equivalent educational backgrounds, community-based practices in the US are not all the same. Student pharmacists can contribute to the design and implementation of revenue-generating services helping individual pharmacies elevate their practice. Doing so involves new models for staffing, workflow, billing, and documentation. Students can help support practice change by focusing on implementation and sustainability. Example APPE integrations focused on community pharmacy practice transformation are described in detail from the University of Arkansas for Medical Sciences College of Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and Idaho State University. IMPLICATIONS: Establishing intentional connections that focus on new sustainable community business models is a responsibility for S/COP. The examples provided serve to demonstrate the feasibility of these partnerships. Training students on innovative practice models and utilizing them is critical in moving community practice forward. As academicians, we must prepare students to be agents of change for the profession and intentionally integrate them into a systematic plan to help promote and change practice activities wherever possible, but especially in community practice.

Pharmacogenomics in a community pharmacy: ACT now.

OBJECTIVE: To highlight the opportunity for community pharmacists to provide pharmacogenomic testing and counseling. DATA SOURCES: Peer-reviewed pharmacy literature. SUMMARY: Pharmacists practicing in community pharmacy are accustomed to optimizing drug therapy through various medication therapy management programs. They use patient-specific information obtained from the patient and their prescribers to cater patient-specific drug regimens. Pharmacogenomics is rapidly evolving, and this field can help optimize medication therapy using an individual's genetic code to identify opportunities for increased or decreased adverse effects or changes in efficacy. Pharmacogenomic testing technology has made conducting pharmacogenomic testing in community pharmacies possible. Pharmacists must arm themselves with the knowledge and skills specific to pharmacogenomics in order to fully integrate this expanding area into patient care and turn this into a great opportunity. CONCLUSION: Advances in knowledge and technology regarding pharmacogenomics coupled with the overwhelming access and use of a community pharmacist by patients provides a tremendous opportunity for community pharmacists to lay claim to the field of pharmacogenomics. Pharmacists are able and needed to provide testing, evaluate results, and offer patient and prescriber education for pharmacogenomics. Pharmacists must take steps to assess the entire clinical picture and use pharmacogenomics where appropriate to optimize drug therapy.

Implementation and assessment of a pilot module on billing for pharmacist-provided healthcare services in a doctor of pharmacy program.

BACKGROUND AND PURPOSE: To describe the implementation and assessment of a pilot module on billing to inform future comprehensive curricular integration of billing for pharmacist-provided healthcare services. EDUCATIONAL ACTIVITY AND SETTING: A module (two-hour didactic session and two-hour lab), developed by a faculty member and pharmacy billing specialist, was piloted to teach second-year pharmacy students how to bill the medical insurance benefit for provided services. Web-based pre- and post-surveys and performance on knowledge assessment questions were used to evaluate the pilot module. FINDINGS: Students' perceptions of their abilities and knowledge to provide and bill for healthcare services improved as a result of participation in the pilot module. SUMMARY: This pilot module on billing was successful in improving students' knowledge and perceptions of abilities to provide and bill for healthcare services. However, further efforts to integrate billing education within individual institutions and the entire pharmacy academy will help better prepare pharmacists to provide sustainable clinical services.

Establishment of a Framework to Support Multi-Faceted Initiatives for Pharmacy-Practice Transformation: Lessons Learned.

We describe the first two years of a multifaceted, five-year program to support sustainable pharmacist-provided health services in Alaska. In 2018, the Alaska Pharmacists Association funded the Sustainable Education and Training Model under Pharmacist as Providers (SETMuPP) to train and support pharmacists to navigate the insurance medical billing process for nondispensing healthcare services. The SETMuPP employed a three-pillar implementation approach: (1) training and practice support infrastructure, (2) PharmD curriculum augmentation, and (3) advocacy and legislative support. The first two years have demonstrated the effectiveness of triad partnerships between professional associations, state policy makers, and academic centers to catalyze meaningful practice transformation.

Patient Satisfaction with Pharmacist-Provided Health-Related Services in a Primary Care Clinic.

(1) Background: Patient satisfaction plays an important role in the perceived value, sustained utilization, and coverage of healthcare services by payers and clinics. (2) Methods: A 33-question survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist in a single primary care facility. It included general items from validated patient satisfaction surveys (i.e., PROMIS®, CAHPS) and pharmacist-specific items identified in selected literature. It was offered to all patients who were presenting for a new, unique visit with the clinical pharmacist at the medical clinic between May 2019 and April 2020. (3) Results: A total of 66 patients agreed to take the survey (RR = 100%), and the responses were overwhelmingly positive. However, men were more likely than women to report higher satisfaction (X2(1, n = 920) = 0.67, p = 0.027), and new patients reported higher satisfaction than existing patients (X2(1, n = 1211) = 1.698, p = 0.037). (4) Conclusions: The findings of this study indicate a high degree of patient satisfaction with pharmacist-provided healthcare services in the primary care setting.

Direct patient care services by community and ambulatory care pharmacists in Idaho.

Background Pharmacists are one of the most accessible but unoptimized healthcare providers in the community. They are medication experts and have authority to independently prescribe in Idaho. Through the provision of direct patient care services (i.e., those distinct from traditional prescription dispensing functions), pharmacists have a greater opportunity to impact chronic disease prevention and management across the state. This can be done by filling gaps in community care (e.g., prescribing recommended therapy) and directly managing and preventing chronic diseases. However, current practices surrounding pharmacist-provided direct patient care services are unknown. Objective To characterize direct patient care services provided by Idaho community and ambulatory care pharmacists as well as to assess individual pharmacists' and their work sites' capacity and barriers in providing and expanding services. Setting Community and ambulatory care pharmacists' work sites in Idaho. Method We administered a cross-sectional, electronic, 20-min survey to Idaho community and ambulatory care pharmacists. Main outcome measure The survey focused on collecting data on current practices, capacity, and barriers related to pharmacist-provided direct patient care services. Results The survey was completed by 280 eligible community and ambulatory care pharmacists with the majority of respondents (n = 250) offering pharmacist-provided direct patient care services. Pharmacists most often prescribed therapy for tobacco cessation (nicotine replacement, bupropion, varenicline), naloxone, and devices for patients with diabetes. Top barriers to individual pharmacists providing services were dispensing load and workload while top barriers to work sites (e.g., environment) were reimbursement/billing, number of available staff, and workflow. Conclusion Idaho community and ambulatory care pharmacists currently offer direct patient care services to patients across the state, but face barriers in providing and increasing services offered.

Rural Community Perceptions and Interests in Pharmacogenomics.

Pharmacogenomics testing is a rapidly expanding field with increasing importance to individualized patient care. However, it remains unclear whether the general public in rural areas would be willing to engage in this service. The objective of this survey was to determine rural community-dwelling members' perceptions of pharmacogenomics. A questionnaire was developed consisting of five Likert-style questions on knowledge and perceptions of pharmacogenomics, a single multiple-choice question on cost of testing, and a free-response question. Two cohorts received the same questionnaire: attendees at a university-sponsored health fair and patients presenting to two independent community pharmacies in southeastern Idaho. While both showed positive reception to the implementation and value of pharmacogenomics, those at the health fair were more in favor of pharmacogenomics, suggesting a need for greater outreach and education to the general public. The findings suggest that interest of rural community-dwelling individuals may be amenable to the expansion of pharmacogenomics testing.