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An Effort to Understand Factors Associated with Variable Veteran Uptake of Pre-emptive Clinical Pharmacogenomics

The VA National Pharmacogenomics Program (NPP) is among the largest pre-emptive clinical pharmacogenomics (PGx) programs in the United States. Pre-emptive testing refers to testing without a specific indication or medication needed to justify testing. The NPP currently offers tests of 11 genes that affect over 40 medications and, to date, has tested over 30,000 Veterans by over 3,000 providers across 60 VA health systems. Initial program data showed variable uptake. Therefore, the NPP evaluation team, funded by a Quality Enhancement Research Initiative (QUERI) partnered evaluation, is exploring factors associated with variability in uptake. The team used program data to identify five facilities with higher and five with lower numbers of PGx orders. From these ten facilities, team members conducted qualitative interviews with 1) chiefs of staff, pharmacy, laboratory, and site champions; 2) high-, medium-, and low-ordering prescribers; and 3) Veterans who accepted and declined PGx testing. Preliminary findings with Veterans suggest that accepters and decliners alike are aware of the logistics, risks, and benefits of testing. These two groups differed in how they weighed the risks versus benefits of testing. Whereas accepters focused on the potential for PGx testing to identify efficacious medications and to reduce side effects and polypharmacy, decliners focused on the potential of data breaches and negative impact of genetic information on insurance coverage. Data from the Corporate Data Warehouse (CDW) are being used to examine factors associated with patient receipt of PGx testing. Among those are demographic characteristics, type of prescriber (MD, pharmacist, or mid-level provider), and prior negative reactions to PGx-targeted medications. Analyses of CDW data and interviews with VA employees are ongoing. Findings will be used to improve patient understanding of the risks and benefits as well as other aspects of program implementation, uptake, and utilization of PGx testing in VA.

Evaluation team: Corrine Voils, PhD, Abigail Silva, PhD, R. Ryanne Wu, MD, MHS, Nina Sperber, PhD, Esra Alagoz, PhD, Diana Gutierrez-Meza, MPH, Karina Melendez, BS, Kara Gavin, PhD, MPH, Allison Hung, MPH, Brian Bartle, MS, Zhiping (Jenny) Huo, MS, Megan Roberts, PhD

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