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The Perceived Value of Pharmacogenetic Testing in Depression Treatment: Mixed-Methods Results From the PRIME Care
Bonnie M Vest1, Laura O Wray1, Leland E Hull1
1Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York-University at Buffalo (Vest), and U.S. Department of Veterans Affairs (VA) Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo (Vest, Wray); Division of General Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston (Hull); Veterans Integrated Services Network (VISN) 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Lynch, Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman); VA Connecticut Healthcare System, West Haven, and Department of Nutritional Sciences, University of Texas at Austin, Austin (Ramsey); VA Rocky Mountain MIRECC for Suicide Prevention, and Division of Hospital Medicine, University of Colorado School of Medicine, Aurora (Simonetti).
Objective:
This mixed-methods study explored providers' perceptions of the value of using pharmacogenetic (PGx) testing in depression treatment after they had used the test during a pragmatic clinical trial.
Methods:
Data were drawn from baseline and follow-up surveys (mental health and primary care providers; N=217) of and qualitative interviews (N=61) with trial participants. Pre-post changes in agreement with statements about PGx testing's value in depression care were examined with a generalized estimating equations cumulative logit ordinal regression model with two time points and robust standard errors. Interviews were analyzed via rapid qualitative analysis.
Results:
Analyses showed greater agreement at follow-up with statements about comfort with PGx testing, feeling well informed about PGx testing, and the strength of the evidence base. Mental health providers had stronger levels of agreement compared with primary care providers. Interview data indicated that although providers found value in PGx testing, they also thought that the test was useful only for some patients. Several providers felt that the main value may be in facilitating patient buy-in to trying medication.
Conclusions:
Overall, this mixed-methods study demonstrated that, after using PGx testing during a clinical trial, primary care and mental health providers have overall positive perceptions of its potential value and utility in depression treatment.
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