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Date of Award

5-2022

Document Type

Thesis - Campus Access Only

Degree Name

MS in Human Genetics

First Advisor

Chantal Duteau Buck

Abstract

Past research has described primary care provider’s (PCP) attitudes toward precision medicine (PM) and their perceived barriers to its integration in their clinical practice. However, no studies focus on provider-specific perspectives of PM in a tribal healthcare context. We performed a secondary analysis of semi-structured interviews with stakeholders previously conducted in 2017 at Southcentral Foundation (SCF), a tribally owned and operated healthcare system in Alaska. We focused on a subset of interviews with PCPs (n=12), defined in this study as any SCF integrated care team member in primary care. We identified categories and themes across all PCP interviews using a hybrid approach of deductive and inductive analysis. Interviewees ranged from physicians, nurse practitioners, behavioral health practitioners, nurse case managers, pharmacists, and other health providers. Six of twelve participants identified as male and five of the twelve participants self-identified as American Indian or Alaskan Native. Providers were generally positive about PM, however they wondered about limitations of PM to address the full health and wellbeing of patients, and expressed a need for increased knowledge of PM. Considerations of the context of SCF included the medical home model structure with integrated care teams, PCPs’ acknowledgment of research transgressions that cultivated mistrust within the patient population, and community-focused values at SCF. Providers identified barriers to integrating precision medicine a SCF but they also described potential methods to facilitate integration. Ultimately, participants’ enthusiasm appeared to outweigh their expressed concerns about PM at SCF. PCP experiences in a unique healthcare system influenced the challenges and facilitators they saw as needed prior to system-wide utilization of PM.

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