FarringtonAs the American College of Clinical Pharmacy (ACCP) works on its Diversity, Equity, Inclusion, and Accessibility (DEIA) initiatives, a question I often receive is how we define groups that are “underrepresented.” This definition can vary depending on the context surrounding the question.
As a pharmacist who works in pediatrics and high-risk obstetrics, I find that most of my patients are underrepresented in clinical research trials. Children are often excluded from clinical trials because of ethical concerns and difficulties obtaining informed consent. This lack of data in children can lead to uncertainties about the appropriate doses and safety of medications for pediatric populations. Women also have historically been underrepresented in clinical trials because of concerns about the potential impact on reproductive health and hormonal balance. Pregnant women are typically excluded from studies because of concerns about potential unknown effects on the developing fetus. This leads to the need to make medical decisions based on a paucity of data in these patient populations.
Pharmacogenomic differences between racial and ethnic groups have been identified. For this and other reasons, results of clinical trials conducted in White subjects may not be applicable to non-White individuals. Older adults are often excluded from clinical trials, despite being a demographic group likely to require medical interventions. Changes in metabolism and renal function as patients age can lead to altered clearance, resulting in drug accumulation and potential toxicity. Potential health disparities and unique health care needs within the LGBTQ+ community are not well studied. Individuals from lower socioeconomic groups or from rural and remote communities often face barriers to participation in clinical trials, such as lack of access to transportation, inability to take time off from work, or limited availability of health care resources in general. Finally, clinical trials often have eligibility criteria that inadvertently exclude individuals with certain disabilities, leading to a lack of data on how treatments and interventions affect this population. Underrepresentation in clinical trials can foster mistrust in the medical and research establishment among some communities. This can further discourage participation in future trials, perpetuating the cycle of underrepresentation.
How can ACCP’s PRNs apply DEIA principles to their activities and initiatives? If the PRN has a research committee, the research design called for in its request for proposals could include diversity and inclusion in subject recruitment, ensuring that participants reflect the full spectrum of patients who might benefit from an intervention. The executive leadership, membership committee, or other group might evaluate the diversity of the PRN’s membership, thereby identifying groups that are underrepresented. A PRN could also determine the number of students, postgraduate year one (PGY1) residents, postgraduate year two (PGY2) residents, and research fellows within its membership. If underrepresented groups are identified through these analyses, are there steps that can be taken to encourage individuals to join ACCP and the PRN? By addressing this question, a PRN might determine how it could better market its unique member benefits and increase engagement with individuals who are underrepresented.
My last comment surrounding DEIA pertains to our ability to enhance inclusion in ACCP. Responses to ACCP surveys indicate that some members do not feel included when they attend PRN functions during an ACCP meeting. This probably stems from the fact that current PRN members are excited to see colleagues (that they may only see infrequently) when they attend a business meeting and networking forum or other PRN function. Amid all the shaking of hands and hugging, those attending their first PRN meeting may feel left out. For ACCP members who accompany individuals new to ACCP, including students and trainees, to a PRN function, I ask that you try to introduce them to colleagues and help them feel welcome. If they express interest in a PRN of which you are not a member, think of a member of that PRN you may know and introduce them to one another. Small steps like these can facilitate newcomers’ introductions to a PRN and allow them to feel a sense of belonging. During the business and networking meetings, consider instituting an ice-breaker activity. This may not be feasible for larger PRNs. However, it may still be possible to have new attendees at individual tables introduce themselves. Including signage on tables exclusively for new attendees could allow PRN members and leaders to easily identify and reach out to “first-timers” and make them feel more welcome.
As ACCP pursues its DEIA initiatives, it is difficult to know how we are progressing since less than 5% of members have updated their member profile to include demographic information. When holding your PRN meetings and through your communications, please encourage members to complete this information in their member profiles. This will greatly enhance our ability to determine whether ACCP and its PRNs are succeeding in making the College a more inclusive organization.
I look forward to seeing many of you at the 2023 ACCP Annual Meeting in Dallas, Texas, November 11–14.