Multisite evaluation of institutional processes and implementation determinants for pharmacogenetic testing to guide...

Area of Science:

• Clinical Pharmacology
• Genetics
• Healthcare Implementation Science

Background:

• Growing interest in pharmacogenetic (PGx) testing to personalize antidepressant selection.
• Lack of clarity on practical implementation strategies for PGx testing in clinical settings.

Purpose of the Study:

• To explore the implementation processes and identify key drivers for successful pharmacogenetic testing for antidepressant guidance across multiple clinical sites.
• To assess the importance of Consolidated Framework for Implementation Research (CFIR) constructs in PGx implementation.

Main Methods:

• Administered two surveys to 17 sites implementing or planning PGx testing for antidepressants.
• Collected data on testing logistics, ordering patterns, gene selection, and result reporting.
• Utilized best-worst scaling choice experiments to rank CFIR constructs' importance.

Main Results:

• Most sites offered PGx testing in outpatient settings, primarily ordered by psychiatry and primary care providers.
• CYP2C19 and CYP2D6 were commonly tested genes, with guidelines from CPIC and FDA informing antidepressant selection.
• Key implementation drivers identified include patient needs, leadership engagement, intervention clarity, evidence strength, and champions.

Conclusions:

• While implementation processes for PGx testing in antidepressant management vary, consistent identification of critical success factors can guide other institutions.
• Understanding and leveraging patient needs, leadership, and strong evidence are vital for effective PGx integration into pharmacotherapy.