pharmacogenomics-supported psychotropic prescribing trial

Conditions: Mental Disorder; Pharmacogenetics; Adverse Drug Reaction (ADR); Effectiveness

Summary: investigate the feasibility and utility of implementing pharmacogenetic testing for adults (aged 18 and older) seeking care for mental illness in inpatient psychiatry clinics in manitoba.

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. although there is some evidence that pgx testing may improve patient outcomes and reduce the length of hospital stays, other studies have not found any benefit of pgx testing on inpatient units. notably, most inpatient studies to date have been conducted outside of canada, mainly in the usa and europe. pgx testing is not offered on inpatient units in manitoba. 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 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 inpatient psychiatry clinics 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 criteria:
inclusion criteria: * presented for services within inpatient units in manitoba * 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

Keywords: adult mental health psychiatry pharmacogenetics depression anxiety ocd psychosis bipolar disorder mental illness