Pharmacogenomics Implementation in Rural and Medically Underserved Settings: A Scoping Review of Programs, Strategies, and Outcomes
Jacqueline Azodoh *
Department of Pharmacy, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina, USA.
Oshoma Erumiseli
Department of Chemistry, Oregon State University, Corvallis, OR, USA.
Lauren T. Prioleau
Department of Pharmacy, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina, USA.
Nhan Tran
Department of Pharmacy, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina, USA.
Jade Frowner
Department of Pharmacy, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina, USA.
Christopher Hudson
Department of Pharmacy, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina, USA.
*Author to whom correspondence should be addressed.
Abstract
Background: Pharmacogenomic (PGx) testing has the potential to improve medication safety and efficacy across a range of therapeutic areas, yet clinical implementation has been concentrated in urban academic medical centers. Rural and medically underserved populations face elevated adverse drug reaction risk and constrained healthcare access but have been relatively excluded from PGx implementation research. Recent growth in this literature warrants a comprehensive scoping review.
Objective: To map and characterize the published literature on PGx implementation in rural and medically underserved settings, identify implementation strategies and reported outcomes, and delineate evidence gaps that warrant future investigation.
Methods: A scoping review was conducted following the Arksey and O'Malley framework and PRISMA-ScR reporting guidelines. Searches were conducted across PubMed, Dimensions ai and Frontiers databases for studies published from 2015 to the search date (March 30, 2026). Reference list screening of identified articles was also carried out in order to enhance the yield. Studies were included if they described a PGx implementation program, educational intervention, or feasibility assessment with a rural or medically underserved population component.
Results: Eighteen studies published between 2015 and 2025 were included in this review. Studies were categorized into five thematic clusters: workforce education programs, pharmacist-led clinical service models, community-engaged implementation with Indigenous and tribal populations, Federally Qualified Health Center pilots, and informatics infrastructure assessments. Most studies reported feasibility and acceptability outcomes; few reported clinical endpoints such as adverse drug reaction reduction, medication adherence, or cost-effectiveness.
Conclusion: Published literature on PGx implementation in rural and underserved populations is growing but remains dominated by feasibility and educational studies rather than outcomes-based clinical research. Key gaps include oncology-specific applications, infrastructure-tiered implementation models among others. Future research should prioritize outcomes-based evaluation and frameworks that account for the heterogeneity of rural healthcare infrastructure.
Keywords: Pharmacogenomics, rural community, health disparities, pharmacist-led interventions, community pharmacy, precision medicine