Overview
Investigate the feasibility and utility of implementing pharmacogenetic testing for adults (aged 18 and older) seeking care for mental illness in Manitoba.
Description
Background and Rationale: Pharmacogenomic (PGx) testing utilizes genetic information as a surrogate marker of a person's ability to process and react to drugs. This information can be used to inform medication selection and dosing, reducing the number of trials needed to choose a suitable medicine. For Manitoba healthcare providers, the only access to psychiatric PGx testing is through commercial providers, costing patients $200 to $2,300. To the best of our knowledge, no study in Manitoba has previously evaluated the feasibility of PGx testing in adult patients seeking care for mental illness.
RESEARCH OBJECTIVES: We aim to investigate the feasibility and utility of implementing PGx testing in Manitoba for adult patients seeking care for mental illness.
Primary Outcome and Measures: Feasibility will be measured along four dimensions:
- Acceptability (satisfaction surveys - patient & clinician)
- Practicality (testing turnaround time)
- Implementation (clinicians' self-reported use of testing results in the prescribing decision-making process)
- Demand (number of referrals, clinicians' self-reported intent to use testing in the future)
Secondary Outcomes and Measures:
- Changes in global functioning and symptom severity [Clinical Global Impression (CGI)
- Severity and Improvement; Brief Psychiatric Rating Scale (BPRS); DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure; Patient Health Questionnaire-9 (PHQ-9); General Anxiety Disorder-7 (GAD-7); Altman Self-Rating Mania Scale (ASRM); Early Psychosis Screener (EPS-26)]
- Adverse drug experience [Frequency, Intensity, Burden of Side Effects Rating (FIBSER)]
- Impact of PGx testing [Changes in medication prescribing and dispensing patterns; changes in healthcare utilization (e.g., inpatient length of stay, mental health resource use, and utilization of healthcare services)
Expected Outcomes: The findings from the proposed study will inform policymakers and facilitate decision-making and priority-setting related to implementing PGx-based psychotropic prescribing policies in Manitoba
Eligibility
Inclusion Criteria:
- Aged 18 years or older
- The initiation, change, dose adjustment, or augmentation of psychotropic medication(s) is indicated
- The treating clinician thinks PGx testing can benefit and refers the patient to the study
Exclusion Criteria:
- Unwillingness to donate saliva samples for genetic analysis
- History of liver or bone marrow (hematopoietic cell) transplantation
- PGx testing results are already available
- No personal health identification number (PHIN) is available