Approaches and hurdles of implementing pharmacogenetic testing in the psychiatric clinic

Abstract

Pharmacogenetic (PGx) testing has emerged as a tool for predicting a person's ability to process and react to drugs. Despite the growing evidence‐base, enthusiasm, and successful efforts to implement PGx testing in psychiatry, a consensus on how best to implement PGx testing into practice has not been established and numerous hurdles to widespread adoption remain to be overcome. In this article, we summarize the most used approaches and commonly encountered hurdles when implementing PGx testing into routine psychiatric care. We also highlight effective strategies that have been used to overcome hurdles. These strategies include the development of user‐friendly clinical workflows for test ordering, use, and communication of results, establishment of test standardization and reimbursement policies, and development of tailored curriculums for educating health‐care providers and the public. Although knowledge and awareness of these approaches and strategies to overcome hurdles alone may not be sufficient for successful implementation, they are necessary to ensure the effective spread, scale, and sustainability of PGx testing in psychiatry and other areas of medicine.

2023 Watch List: Top 10 Precision Medicine Technologies and Issues

“…60 As of yet, clinical adoption of the technology in Canada and across the globe remains limited due to uncertainties about clinical utility and relevance of test findings to individuals, among other barriers. 58,60,61 Research examining the effectiveness of pharmacogenomics testing, in particular for guiding the treatment of depression, is emerging; however, to date, the findings remain mixed, with studies indicating both significant improvements and no difference in clinical outcomes compared with usual care. 57,58,62 A qualitative study reported that people in Canada with lived experiences and health care professionals are hopeful about the technology but are also awaiting more robust clinical and economic evidence.…”

A Narrative Review on Pharmacogenomics in Psychiatry

“…67, 68, and 69, just to cite a few) with the aim of implementing strategies to overcome them. 70 Indeed, a general lack of support for such testing in psychiatry has been highlighted because of the absence of standardized clinical protocols, regulations, and easy-to use workflows to guide psychiatrists, uncertainty concerning cost-effectiveness that varies significantly among countries, the entire cost of testing paid by patients with no reimbursement by health care systems, and uncertainty about regulatory policies concerning the management of PGx data with consequent ethical and legal drawbacks. Moreover, uncertainty about the clinical efficacy and generalizability of PGx testing has spread, as many studies have been conducted on relatively small samples and have been not adequately controlled for significant confounding factors.…”

“…Therefore, further research is warranted to replicate findings in much larger data sets with the necessary statistical power, accounting for confounding factors such as placebo effects, adherence to treatments, concurrent medications, clinical symptoms, and population stratification 67 . In addition, most of the largest studies published to date have been sponsored by commercial laboratories and have used commercial combinatorial tests, raising concerns about conflict of interest, transparency, and, once again, generalizability of evidence 70 …”

“…At last, although not within the primary scope of this review, it is essential to acknowledge the extensive research conducted to identify the key factors contributing to the cautious stance of clinical psychiatry regarding the integration of routine PGx testing (check all Refs. 67,68, and 69, just to cite a few) with the aim of implementing strategies to overcome them 70 . Indeed, a general lack of support for such testing in psychiatry has been highlighted because of the absence of standardized clinical protocols, regulations, and easy-to use workflows to guide psychiatrists, uncertainty concerning cost-effectiveness that varies significantly among countries, the entire cost of testing paid by patients with no reimbursement by health care systems, and uncertainty about regulatory policies concerning the management of PGx data with consequent ethical and legal drawbacks.…”

The emergence, implementation, and future growth of pharmacogenomics in psychiatry: a narrative review

“…Pharmacogenomics (PGx) (i.e. the study and use of an individual's genomic information to predict response to medications) is one such strategy that has gained significant momentum and is fueling the precision psychiatry movement (Maruf & Bousman, 2022).…”