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Published Online: 2 August 2023

Providers’ Use of Pharmacogenetic Testing to Inform Antidepressant Prescribing: Results of Qualitative Interviews

Abstract

Objective:

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.

Methods:

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.

Results:

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.

Conclusions:

To support future implementation, policies and procedures are needed, as well as mechanisms to support ongoing provider education on PGx.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 1270 - 1276
PubMed: 37528698

History

Received: 17 October 2022
Revision received: 23 March 2023
Accepted: 26 April 2023
Published online: 2 August 2023
Published in print: December 01, 2023

Keywords

  1. Pharmacogenetics
  2. Depression
  3. Primary Care
  4. Mental Health
  5. Qualitative Research
  6. Antidepressants

Authors

Details

Bonnie M. Vest, Ph.D. [email protected]
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).
Laura O. Wray, Ph.D.
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).
Michael E. Thase, M.D.
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).
Laura A. Brady, Ph.D.
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).
Sara R. Chapman, M.S., O.T.R./L.
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).
David W. Oslin, M.D.
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).

Notes

Send correspondence to Dr. Vest ([email protected]).

Competing Interests

Dr. Wray has received support from the VA Center for Integrated Healthcare and the VA Western New York Healthcare System, Buffalo. Dr. Thase has served as an adviser or consultant for Acadia, Akili, Alkermes, Allergan (Forest, Naurex), Axsome, Boehringer-Ingelheim, Clexio Biosciences, GH Therapeutics, H. Lundbeck A/S, Janssen Pharmaceuticals (Johnson and Johnson), Jazz Pharmaceuticals, Otsuka Pharmaceuticals, Perception Neuroscience, Pfizer, Sage Therapeutics, Seelos Pharmaceuticals, Sunovion, and Takeda; he has received grant support from AbbVie, Acadia, Allergan (Forest, Naurex), Alkermes, Assurex Health (now Myriad), Axsome Therapeutics, Clexio, Intracellular, Janssen Pharmaceuticals (Johnson and Johnson), NIMH, Otsuka, the Patient-Centered Outcomes Research Institute, and Takeda; and he receives royalties from the American Psychiatric Association, Guilford Press, Herald House, and W.W. Norton. His spouse is employed by Peloton Advantage and is a senior vice president of Open Health; both of these companies conduct business with pharmaceutical companies. Dr. Oslin has received research support from Johnson and Johnson and Myriad Genetics. The other authors report no financial relationships with commercial interests.

Funding Information

This work was supported by the VA (Health Services Research and Development SDR-16-348). Additional support was received from Myriad Genetics (in-kind testing support) and from Johnson and Johnson (grant support for a substudy).These views represent the opinions of the authors and not necessarily those of the VA or the U.S. government.

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