Duke University, Durham, North Carolina, USA.
Durham VA Health Care System, Durham, NC, United States.
Clin Transl Sci. 2024 Jun;17(6):e13837. doi: 10.1111/cts.13837.
Pharmacogenetic testing could reduce the time to identify a safe and effective medication for depression; however, it is underutilized in practice. Major depression constitutes the most common mental disorder in the US, and while antidepressant therapy can help, the current trial -and error approach can require patients to endure multiple medication trials before finding one that is effective. Tailoring the fit of pharmacogenetic testing with prescribers' needs across a variety of settings could help to establish a generalizable value proposition to improve likelihood of adoption. We conducted a study to explore the value proposition for health systems using pharmacogenetic testing for mental health medications through prescribers' real-world experiences using implementation science concepts and systematic interviews with prescribers and administrators from four health care systems. To identify a value proposition, we organized the themes according to the Triple Aim framework, a leading framework for health care policy which asserts that high-value care should focus on three key metrics: (1) better health care quality and (2) population-level outcomes with (3) reduced per capita costs. Primary care providers whom we interviewed said that they value pharmacogenetic testing because it would provide more information about medications that they can prescribe, expanding their ability to identify medications that best-fit patients and reducing their reliance on referrals to specialists; they said that this capacity would help meet patients' needs for access to mental health care through primary care. At the same time, prescribers expressed differing views about how pharmacogenetic testing can help with quality of care and whether their views about out-of-pocket cost would prevent them from offering it. Thus, implementation should focus on integrating pharmacogenetic testing into primary care and using strategies to support prescribers' interactions with patients.
基因药理学检测可以减少确定安全有效的抑郁症治疗药物的时间；然而，它在实践中并未得到充分利用。重度抑郁症是美国最常见的精神障碍，尽管抗抑郁治疗可能会有所帮助，但目前的试错方法可能需要患者多次尝试药物，才能找到有效的药物。在各种环境中，根据临床医生的需求调整基因药理学检测的适配性，可能有助于建立一个可推广的价值主张，从而提高采用的可能性。我们进行了一项研究，通过实施科学概念和对来自四个医疗系统的临床医生和管理人员进行系统访谈，探讨了通过临床医生的实际经验，在精神健康药物方面使用基因药理学检测对卫生系统的价值主张。为了确定一个价值主张，我们根据三重目标框架（一种领先的医疗保健政策框架）组织了主题，该框架断言高价值的医疗保健应该集中在三个关键指标上：（1）更好的医疗保健质量和（2）人群水平的结果，同时（3）降低人均成本。我们采访的初级保健提供者表示，他们重视基因药理学检测，因为它可以提供更多关于他们可以开处方的药物的信息，扩大他们识别最适合患者的药物的能力，并减少他们对专科医生转诊的依赖；他们表示，这种能力将有助于通过初级保健满足患者获得精神保健的需求。与此同时，临床医生对基因药理学检测如何帮助提高护理质量以及他们对自付费用的看法是否会阻止他们提供检测表达了不同的看法。因此，实施应侧重于将基因药理学检测整合到初级保健中，并使用策略来支持临床医生与患者的互动。
