Cernat Alexandra, Abelson Julia, Samaan Zainab, Ramdyal Amanda, Vanstone Meredith
Department of Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
Health Policy PhD Program, Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
BMJ Open. 2025 Aug 27;15(8):e091562. doi: 10.1136/bmjopen-2024-091562.
Many patients with major depressive disorder must try multiple antidepressants before they identify a drug that is both effective and tolerable. Pharmacogenomic (PGx) testing may provide clinicians with guidance around medication choice based on a patient's drug response-related genetic variants. However, this technology is not routinely used in clinical care in Canada, and the views of key actors in the implementation process are largely unknown. The objective of this study was to qualitatively elicit the perspectives and attitudes of clinicians, scientists, policy actors and members of industry about PGx testing to guide antidepressant prescribing in primary care via interviews to help inform implementation policies for this technology.
We conducted a qualitative description study. Data analysis proceeded in parallel with data collection and consisted of an inductive qualitative content analysis.
The focus of this study was implementation of PGx testing in primary care in Ontario, Canada.
We conducted semistructured interviews with 28 individuals who had professional experience relevant to the implementation of PGx testing for depression care ('key informants'). Geographical limits for recruitment were applied based on the transferability of key informants' expertise to the Ontario setting; included participants worked in Canada, the USA and Europe.
Participants described views about PGx testing relating to benefits and harms of this technology; their interpretation of the evidence base; implementation-oriented considerations and industry involvement. Overall, participants spoke enthusiastically about PGx testing, but emphasised genetic information is only one component of decision-making about medication prescription. Most endorsed implementation in primary care and felt a pre-emptive approach to testing would be ideal.
Key informants consider the use of PGx testing to guide antidepressant prescribing in primary care as having both patient-level and system-level benefits. Concerns raised centred primarily around clinician education and barriers to access. Future research should focus on questions relating to feasibility of system-wide implementation.
许多重度抑郁症患者必须尝试多种抗抑郁药物，才能找到一种既有效又可耐受的药物。药物基因组学（PGx）检测可为临床医生提供基于患者药物反应相关基因变异的用药选择指导。然而，这项技术在加拿大的临床护理中并未常规使用，实施过程中关键参与者的观点也大多不为人知。本研究的目的是通过访谈定性地了解临床医生、科学家、政策制定者和行业成员对PGx检测的看法和态度，以指导初级保健中的抗抑郁药物处方，从而为该技术的实施政策提供信息。
我们进行了一项定性描述研究。数据分析与数据收集同步进行，包括归纳性定性内容分析。
本研究的重点是在加拿大安大略省的初级保健中实施PGx检测。
我们对28名具有与抑郁症护理中PGx检测实施相关专业经验的个人（“关键信息提供者”）进行了半结构化访谈。根据关键信息提供者的专业知识向安大略省环境的可转移性应用了招募的地理限制；纳入的参与者在加拿大、美国和欧洲工作。
参与者描述了关于PGx检测的观点，涉及该技术的益处和危害；他们对证据基础的解释；以实施为导向的考虑因素和行业参与情况。总体而言，参与者对PGx检测充满热情，但强调基因信息只是药物处方决策的一个组成部分。大多数人支持在初级保健中实施，并认为抢先检测方法是理想的。
关键信息提供者认为，在初级保健中使用PGx检测来指导抗抑郁药物处方对患者层面和系统层面都有益处。提出的担忧主要集中在临床医生教育和获取障碍方面。未来的研究应关注与全系统实施可行性相关的问题。
