Clinical diagnostics’ expanding role in rural care delivery

Rural health practices face persistent pressure to improve outcomes, manage rising costs, and support clinicians with limited resources. As diagnostics evolve beyond disease detection, they are becoming powerful tools to address these challenges by guiding treatment decisions and reducing reliance on a reactive care strategy that can be inefficient and expensive. Therapeutic testing solutions, such as pharmacogenomics and therapeutic drug monitoring, offer a practical, scalable way for rural health providers to personalize therapies to improve patient care outcomes and increase the efficiency of care delivery.

Moving beyond reactive care

Traditionally, diagnostic tests have been used to identify and classify diseases. That foundational function remains essential, but clinical testing is now evolving beyond detection and diagnosis to increasingly guide therapeutic decisions. This growing role in guiding therapeutic decisions enables faster, more effective treatments. For rural practices where access to specialty care may be limited and clinicians often manage complex conditions across broad patient populations, therapeutic testing can serve as a valuable decision support tool.

Traditional treatment models rely heavily on population-based evidence. Clinicians select therapies that work for most patients and adjust them based on observed responses. While effective at scale, this approach relies heavily on population‑level data and doesn’t fully account for potential variation in individual responses due to genetic differences, comorbidities, environmental factors, and medication adherence.  

Diagnostics are changing that dynamic by enabling more informed decisions before treatment begins and supporting a more personalized approach to care. Pharmacogenomic (PGx) testing helps identify how genetic variants affect a patient’s response to medications. Notably, 99 percent of individuals carry clinically actionable variants that affect drug metabolism. By identifying these variants before treatment begins, clinicians can select medications that are more likely to be safe and effective for each patient. This is a foundational shift from reactive care to predictive, personalized decision-making that reduces the risk of adverse events and prevents delays in effective treatment.

Therapeutic drug monitoring (TDM) is another diagnostic tool aimed at improving therapy. Personalized care does not end once a treatment plan is selected. Patients’ responses can change over time, influenced by metabolism, adherence, disease progression, medications, and their immune response. TDM helps assess how a patient responds after therapy is initiated by measuring drug concentrations — and, when relevant, antidrug antibodies — to ensure medications remain within therapeutic ranges. This is especially important for medications with narrow therapeutic windows and allows clinicians to proactively adjust therapies.

Practical applications in rural health

Pharmacogenomics, TDM, and similar solutions help patients reach therapeutic goals faster while minimizing adverse effects. The applications of these emerging diagnostic tools range from supporting highly specialized care, such as cancer and transplant, to primary care. Their value is evident in conditions frequently managed in rural health settings, including the following examples:

• Antihypertensive drug monitoring provides a clear example of how these tools can support rural care. Patient populations in rural areas experience high rates of cardiovascular disease, meaning many rural providers encounter hypertension. It can be especially challenging to manage resistant hypertension, which occurs when a patient’s blood pressure remains uncontrolled despite multiple medications. Prescription nonadherence is a common cause of inadequate response but is often difficult to identify using self‑reported adherence or prescription refill data alone. Laboratory testing that detects antihypertensive medications in urine provides an objective way to determine whether prescribed therapies are being taken. This insight allows clinicians to distinguish true treatment resistance from nonadherence, enabling more appropriate therapy adjustments and avoiding unnecessary medication escalation.
• Depression and behavioral health management represent another critical application for rural practices. Major depressive disorder affects millions of Americans. Many patients do not respond to initial antidepressant therapy in part because of genetic variations that influence how patients metabolize commonly prescribed antidepressants. PGx testing helps clinicians identify effective medications based on a patient’s genetic profile. Additionally, TDM performed after therapy starts helps assess whether drug concentrations are optimal.
• Substance use disorder and controlled substance monitoring are also relevant in rural practices. Objective drug testing supports evidence‑based addiction treatment by assessing recent drug use, monitoring adherence, and helping clinicians evaluate the effectiveness of treatment plans. In pain management, TDM aligns with professional guidelines recommending laboratory testing to help manage the risks of misuse and diversion associated with controlled substances. These applications of diagnostics support safer prescribing.
• Diagnostics for anti-seizure medications support clinicians caring for patients with epilepsy. Finding the right medication or combination of medications to achieve stable seizure control can be a lifelong challenge. Integrating PGx testing and TDM enables safe and effective anti-seizure therapy. For patients who are refractory and require higher amounts of a medication, TDM helps quantify whether concentrations remain within the therapeutic range.
  
  

The benefits of therapeutic testing for patients and rural care teams

As health care shifts toward personalized, value‑based care, therapeutic testing is emerging as a critical tool for improving outcomes by empowering clinicians with reliable data and actionable insights that ensure treatments are tailored, effective, and timely. This precision helps patients achieve therapeutic goals faster, minimizes adverse effects, and increases confidence in care plans. The improved outcomes made possible with these new therapeutic testing tools translate into fewer follow‑up visits, greater patient confidence in care plans, and more efficient use of limited clinical staff and resources.

Furthermore, ineffective therapies, delayed adjustments, and unrecognized nonadherence drive unnecessary prescribing and related expenses. Therapeutic testing helps address these gaps by providing objective insights into whether a medication is delivering benefits, enabling earlier modification or discontinuation. This reduces unnecessary prescriptions and out‑of‑pocket costs for patients, while helping clinics minimize avoidable visits, manage side effects more efficiently, and align with value‑based care. In resource‑constrained settings, these efficiencies support better use of clinical time and financial resources without compromising care quality.

A practical path forward

For rural health providers, therapeutic testing offers a practical path forward in an increasingly complex care environment. By moving diagnostics beyond disease detection to guide therapy selection and adjustments, tools such as pharmacogenomics and therapeutic drug monitoring help reduce reactive care to improve safety and accelerate patient response. These capabilities support better outcomes for patients, more efficient use of limited resources for providers, and greater confidence in care decisions.

NRHA adapted the above piece from Mayo Clinic Laboratories, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.
 

Matthew Binnicker, Ph.D., is the chief scientific officer of Mayo Clinic Laboratories. He joined Mayo Clinic in 2004 and, in his current role as chief scientific officer, Dr. Binnicker spearheads the scientific endeavors of Mayo Clinic Laboratories and leads business product research, design, and development initiatives.