Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman).
Psychiatr Serv. 2023 Dec 1;74(12):1270-1276. doi: 10.1176/appi.ps.20220537. Epub 2023 Aug 2.
Pharmacogenetic testing (PGx) for patients experiencing depression has been associated with modest improvements in symptoms. However, little is known about providers' use of PGx, including how and for whom providers use the test results in clinical decision making. In this article, results from qualitative interviews on the experience of providers participating in a pragmatic trial of PGx are described; implications of the providers' experiences are highlighted to inform future implementation of PGx.
Interviews were conducted with providers participating in the trial (N=61) who treated veterans who had depression. Questions were informed by the Consolidated Framework for Implementation Research. A rapid analytic approach was used.
Two main themes were identified: perceptions regarding which patients would likely benefit from PGx and approaches to using the test results in prescribing. Providers generally expressed positive experiences with using PGx results. However, the providers varied in application of the test results to clinical decision making regarding medications, were uncertain about how much to rely on the results, and differed in perceptions about which patients would benefit from PGx.
To support future implementation, policies and procedures are needed, as well as mechanisms to support ongoing provider education on PGx.
针对抑郁症患者的药物遗传学检测（PGx）与症状的适度改善相关。然而，对于提供者如何以及为谁在临床决策中使用检测结果，人们对 PGx 的使用知之甚少。本文描述了参与 PGx 实用试验的提供者的经验的定性访谈结果；强调提供者经验的意义，为未来的 PGx 实施提供信息。
对参与试验的提供者（N=61）进行了访谈，这些提供者治疗患有抑郁症的退伍军人。问题是根据综合实施研究框架提出的。使用了快速分析方法。
确定了两个主要主题：对哪些患者可能受益于 PGx 的看法，以及在开处方时使用检测结果的方法。提供者普遍对使用 PGx 结果的体验表示肯定。然而，提供者在将检测结果应用于药物治疗的临床决策方面存在差异，对于应该在多大程度上依赖结果感到不确定，并且对哪些患者将受益于 PGx 的看法存在差异。
为了支持未来的实施，需要制定政策和程序，以及支持提供者持续进行 PGx 教育的机制。
