Clinicians expressed greater comfort with and confidence in pharmacogenetic testing (PGx) after participation in a clinical trial that employed PGx for depressed patients, according to a report published today in Psychiatric Services.
Some clinicians were uncertain about which patients might be best served by these tests, while others expressed concerns about cost. But there was a general perception that part of the test’s value was its potential to help patients with buy-in and confidence regarding medication treatment.
“Exposure to this novel practice is necessary to help providers understand its potential usefulness and how they may apply testing results in their clinical management of patients with depression,” wrote Bonnie M. Vest, Ph.D., of the State University of New York–University at Buffalo, and colleagues.
The Precision Medicine in Mental Health Care (PRIME Care) study was a randomized controlled trial to assess whether using a commercially available PGx test improved outcomes in patients with depression. All participating clinicians completed a baseline survey between July 2017 and January 2021. The survey assessed demographic information as well as comfort with and perceptions of PGx testing rated on a five-point Likert scale.
A follow-up survey was conducted between December 2020 and March 2021 after PRIME Care concluded. A total of 217 clinicians completed both surveys, and 61 also took part in qualitative interviews. Overall, 72% of those who completed the survey and 80% of those who participated in interviews worked in specialty mental health clinics; 62% and 72%, respectively, completed medical training.
Following the trial, 31% of clinicians strongly agreed with the statement “I feel comfortable ordering a pharmacogenetic test to predict risk of adverse events or the likelihood of a treatment response” compared with 15% before the study. Further, 38% strongly agreed with the statement “I feel well informed about the role of pharmacogenetic testing in choosing a psychotropic medication” compared with 21% before the trial. Mental health clinicians were much more likely than primary care ones to provide positive answers.
Qualitative interviews revealed more nuance. One provider responded: “I do feel patients have felt more confident about trying medications with that information, so I think there is some positive value.... I wouldn’t say it’s game changing.” Another provider said: “If it’s cost-effective enough to do it at the beginning, it might be worth it just to eliminate a lot of the guesswork…. I think cost would be prohibitive as far as just doing it on every patient.”
The authors concluded: “A pressing need exists for further research, including cost-benefit analyses, to inform decisions about PGx implementation. Specifically, our findings highlight providers’ concerns about patient-level criteria and when during treatment PGx testing is most beneficial.”
For related information, see the Psychiatric News article “Pharmacogenomic Testing May Help Achieve Better Patient Outcomes, Less Toxicity.”
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