Silva Abigail, Voora Deepak, Wu Rebekah Ryanne, Bartle Brian, Chanfreau-Coffinier Catherine, Hung Allison, Voils Corrine I
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL; Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL.
VA National Pharmacogenomics Program, Department of Veteran's Affairs, Durham, NC; Department of Medicine, Duke Precision Medicine Program, Duke University School of Medicine, Durham, NC.
Genet Med. 2025 Mar;27(3):101308. doi: 10.1016/j.gim.2024.101308. Epub 2024 Oct 29.
Better understanding patient uptake of pharmacogenomic (PGx) testing may inform its implementation and maximize the benefits that such testing can confer. This study examined patient and provider factors associated with PGx test ordering in a national health care system in which panel-based testing was implemented as part of routine care.
We used a retrospective matched cohort design and data from the Veterans Health Administration Corporate Data Warehouse. A conditional logistic model was used to identify factors associated with a PGx order receipt and estimate odds ratios and 95% confidence intervals.
The following patient factors predicted receipt of a PGx test order: younger age, married status, rural residence, non-Hispanic Black or Hispanic race/ethnicity, PGx educational mailer receipt, depression diagnosis, allergy to a drug on the panel, prescriptions for drugs on the panel, and specialty care visits (P < .05). Additionally, patients whose providers were female, younger, a nurse practitioner/physician assistant or pharmacist, or participated in an educational mailer program were more likely to receive an order (P < .05).
This study highlights factors that may facilitate or hinder the widespread and equitable implementation of PGx testing in a large national health care system. The information is being used to further refine the program.
更好地了解患者对药物基因组学（PGx）检测的接受情况，可为其实施提供参考，并使此类检测的益处最大化。本研究调查了在一个将基于检测板的检测作为常规护理一部分实施的国家医疗保健系统中，与PGx检测医嘱相关的患者和提供者因素。
我们采用回顾性匹配队列设计，并使用退伍军人健康管理局企业数据仓库中的数据。使用条件逻辑模型来识别与收到PGx检测医嘱相关的因素，并估计比值比和95%置信区间。
以下患者因素可预测收到PGx检测医嘱：年龄较小、已婚、居住在农村、非西班牙裔黑人或西班牙裔种族/族裔、收到PGx教育邮件、诊断为抑郁症、对检测板上的一种药物过敏、开具检测板上药物的处方以及接受专科护理（P < 0.05）。此外，提供者为女性、较年轻、是执业护士/医师助理或药剂师，或参加了教育邮件项目的患者更有可能收到检测医嘱（P < 0.05）。
本研究突出了在一个大型国家医疗保健系统中可能促进或阻碍PGx检测广泛且公平实施的因素。这些信息正被用于进一步完善该项目。
