What Are the Barriers and Enablers to the Implementation of Pharmacogenetic Testing in Mental Health Care Settings?

Abstract

In psychiatry, the selection of antipsychotics and antidepressants is generally led by a trial-and-error approach. The prescribing of these medications is complicated by sub-optimal efficacy and high rates of adverse drug reactions (ADRs). These both contribute to poor levels of adherence. Pharmacogenetics (PGx) considers how genetic variation can influence an individual’s response to a drug. Pharmacogenetic testing is a tool that could aid clinicians when selecting psychotropic medications, as part of a more personalized approach to prescribing. This may improve the use of and adherence to these medications. Yet to date, the implementation of PGx in mental health environments in the United Kingdom has been slow. This review aims to identify the current barriers and enablers to the implementation of PGx in psychiatry and determine how this can be applied to the uptake of PGx by NHS mental health providers. A systematic searching strategy was developed, and searches were carried out on the PsychInfo, EmBase, and PubMed databases, yielding 11 appropriate papers. Common barriers to the implementation of PGx included cost, concerns over incorporation into current workflow and a lack of knowledge about PGx; whilst frequent enablers included optimism that PGx could lead to precision medicine, reduce ADRs and become a more routine part of psychiatric clinical care. The uptake of PGx in psychiatric care settings in the NHS should consider and overcome these barriers, while looking to capitalize on the enablers identified in this review.

Best–worst scaling methodology to evaluate constructs of the Consolidated Framework for Implementation Research: application to the implementation of pharmacogenetic testing for antidepressant therapy

“…Few centers have formalized processes for clinical PGx testing due to several implementation challenges [ 28 , 29 ]. Our latent class analysis of the BWS ranking of CFIR constructs in centers that have implemented or are planning to implement PGx testing aligns with the results of previous studies that have reported on facilitators and barriers of PGx implementation [ 17 , 28 – 30 ].…”

Approaches and hurdles of implementing pharmacogenetic testing in the psychiatric clinic

“…The RCTs that have evaluated PGx-guided versus unguided (standard) prescribing in psychiatry have been sponsored by commercial laboratories and most have utilized proprietary combinatorial testing, raising concerns about conflicts of interest and transparency, respectively. 38 A meta-analysis of five…”

“…The most consistent hurdles to PGx testing identified by numerous studies 29,[35][36][37][38]72,73 are knowledge and education gaps among physicians, pharmacists, genetic counsellors, nurse practitioners, and the public. Studies to date suggest that 80%-90% of health-care professionals agree about the value of PGx testing in drug selection and dose optimization; however, only 10%-20% are properly trained or confident enough to routinely use PGx testing in their practice.…”

Pharmacogenetics: optimising prescribing in primary care

“…Education, training and clinical informatics represent some of the greatest challenges to widespread adoption. Prescribers require clear, simple, clinically relevant information at the point of prescribing to facilitate implementation 11 . Incorporating models of care, where pharmacologists, pharmacists and other healthcare professionals work in multidisciplinary teams providing PGx interpretation, could support primary care doctors to improve patient care without additional workload 12 …”