Estimating the Value of Patient Engagement Outcomes in Precision Medicine to Eliminate Health Disparities in US American Indian Tribal Communities: Discriminant Analysis

Abstract

Objectives: To describe the value of pharmacist-led dialogue intervention within traditional communities in early Precision Medicine Initiatives to reduce mortality rates in Native American Midwestern tribes due to multiple chronic conditions (MCC). Method(s): Research Design: Descriptive, cross-sectional survey using mixed-methods approach. Data Source: In-person interview tribal survey of 2 main tribal populations, 2013 - 2015. Study Population: 14 federally designated tribes in Midwestern States with adults aged 18 years and older were identified within the 2 main tribes of research interest, depression history + one prescription medication and living on the reservation, (N = 621). Outcomes and measures: Dependent categorical variable, traditional healing practices, were defined as the main variable of interest. Independent variables included 139 traditional Native American daily activities, Likert scaling technique identified strength of practices, and summed count outcomes (such as "how many times a respondent sought healing advice from the pharmacist") defined this population. Exclusion: Pregnant, not living on the reservation, and over age of 85. Qualitative comments (n= 42) analyzed through cluster analysis for thematic domains. Word Cloud using NVivo11 revealed the most frequently used words within the comments. SPSS ver. 22. Statistical analysis: Descriptive approach to demographic data and inferential statistics, using discriminant analysis for group membership in traditional healing practices, summed count and qualitative comments were included in the results. Pearson Chi-square = 92.8. Result(s): Statistics reveal 70% of tribal respondents live and follow traditional Ojibwe lifestyles; 64% vs. 35% participate in traditional activities; 93% of respondents state they are happy but are still prescribed medications for depression. 96% do not know how a pharmacist can help them but would be more than willing to seek consultation for medication, consistent with informed knowledge that Precision Medicine Initiative may improve their health outcomes. Conclusion(s): Dialogue with a pharmacist improves initiation of Precision Medicine intervention.