Screening for pharmacogenetic testing eligibility: a quality improvement project in an outpatient mental health clinic

Abstract

Background: Variability in drug metabolism, side effects, and predictability of medication response remain challenging for prescribers across medical specialties. Psychiatry's use of a trial-and-error approach often leads to prolonged drug trials, adverse side effects, and poor symptom improvement before an appropriate medication is selected. Advancements in precision medicine have led to the use of pharmacogenetic testing (PGx) to address these challenges by understanding how human genes interact with medications. Local Problem: At one outpatient psychiatry clinic, the regular use of PGx testing is limited by a non-systematic method of identifying patients. This approach has led to patients being overlooked entirely or only offered testing after experiencing an adverse side effect. Methods: A brief staff/patient-administered screening tool was developed and implemented over a 6-week period in an outpatient psychiatric clinic. The PDSA cycle was utilized throughout the implementation period and included staff feedback. Intervention: A standardized screening tool based on provider subjective criteria and patient interest was developed and integrated into the EHR forms with the goal of systematically identifying patients who may benefit from the intervention. Results/Conclusion: A total of 86 appointments occurred that were considered eligible for screening. 71 of those 86 were screened. 51.2% of screening tools were completed correctly and 33.3% were partially or incorrectly completed. 70.4% of patients screened had already completed PGx testing prior to this project implementation. No prior baseline patient identification data for PGx testing at the clinic is available due to inconsistent documentation and the absence of a formal process. This was a novel intervention and no external comparisons are available. The most frequently cited reason for declination/deferment of PGx testing was cost/insurance not covering the cost.