Lead/Presenter: Laura Wray,
VA Center for Integrated Healthcare
All Authors: Wray LO (University at Buffalo, Jacobs School of Medicine and Biomedical Sciences), Vest, BM (University at Buffalo, Jacobs School of Medicine and Biomedical Sciences), Brady, LA (University at Buffalo, Jacobs School of Medicine and Biomedical Sciences) Hull, LE (Boston VA Healthcare System, VA CHOIR, Bedford/Boston COIN) Beehler, GP (VA Center for Integrated Healthcare, University at Buffalo, School of Public Health and Health Professions) Chapman, SR (VISN 4 MIRECC, Pittsburgh VAMC) Thase, ME (VISN 4 MIRECC, Corporal Michael J. Crescenz VAMC, University at Pennsylvania, Perelman School of Medicine) Oslin, DW (VISN 4 MIRECC, Corporal Michael J. Crescenz VAMC, University at Pennsylvania, Perelman School of Medicine)
There is limited literature on providers' knowledge and attitudes towards the use of pharmacogenetic (PGx) testing to inform depression prescribing and how to best implement this technology into practice. The Precision Medicine in Mental Health Care (PRIME Care) study is a large pragmatic trial that incorporates implementation science while examining the utility of PGx for depression. At study initiation, we sought to: 1) understand provider perceptions of PGx testing for depression prescribing; 2) identify factors that would be important for successful completion of the trial; and 3) develop information to inform future implementation of PGx testing for mental health treatment.
Focus groups were conducted with thirty-one providers (16 primary care, 15 mental health from six PRIME Care study sites. Consolidated Framework for Implementation Research (CFIR) innovation characteristics domain constructs were used to develop interview guides and the qualitative codebook. Focus group transcripts were analyzed using rapid analytic procedures.
Analysis revealed 4 main themes: 1) providers had limited experience with PGx testing and limited knowledge of the PGx evidence base, particularly for psychiatric medications; 2) providers were cautiously optimistic that PGx could increase their precision in depression prescribing and improve patient engagement, but uncertain how much results would influence treatment; 3) providers were concerned how to incorporate PGx into current workflow and about potential misinterpretation of PGx reports by patients; 4) primary care providers were less familiar and comfortable with mental health PGx testing than mental health providers.
While providers held favorable attitudes towards PGx, additional education on its evidence and use was desired. Clinical utility was seen as especially important when considering future implementation. Findings were used to support the implementation of the randomized controlled trial (RCT) component of the PRIME Care study.
Implementation science methods can be incorporated into a large RCT to contextualize trial findings, and to understand stakeholder-identified barriers and facilitators. Gaining this knowledge early in the research pipeline is likely to speed post-trial implementation and scale-up for efficacious innovative health care practices.