Primary Care Providers' Interest in Using a Genetic Test to Guide Alcohol Use Disorder Treatment.
Efforts to identify genetic moderators of pharmacotherapy response have generated interest in clinical applications of pharmacogenetic tests in alcohol use disorder (AUD) treatment. To date, no research on providers' interest in using pharmacogenetic tests in the context of AUD treatment has been reported. We conducted qualitative interviews with primary care providers from 5 clinics in the Veterans Health Administration (VA) to assess their interest in using a hypothetical genetic test to inform treatment of AUD with pharmacotherapy.



Key contacts were used to recruit 24 providers from 5 primary care clinics associated with a single large VA medical facility. Participants completed 30-minute in-person semi-structured interviews focused on barriers and facilitators to provision of pharmacotherapy for AUD. Interviews included a hypothetical scenario regarding the availability of a genetic test to inform AUD pharmacotherapy provision and/or selection. Provider responses to the hypothetical scenario were recorded, transcribed and analyzed qualitatively using inductive content analysis. Data were independently coded by three investigators, and themes were identified via consensus.



Participants were generally interested in a genetic test to aid in AUD treatment planning. Five common themes were identified, including: perceived benefits of a pharmacogenetic test (e.g., aiding with therapeutic choice, positively impacting patient motivation for and engagement with AUD treatment), perceived drawbacks (e.g., limiting potential benefits of pharmacotherapy by reducing the target population for its receipt, adverse impacts of "negative" results), caveats to clinical utility (e.g., utility would depend on prognostic accuracy and/or medication characteristics), uncertainty as to whether such a test would impact clinical decision-making, and pragmatic barriers to use (costs and other resources, such as laboratory facilities).



Primary care providers in this study generally believed a genetic test to aid in AUD treatment planning would be useful, due to its potential to hone treatment choice as well as to influence patient motivation and adherence to treatment. However, providers acknowledged that a test's utility would depend on the strength of its prognostic characteristics, its other benefits relative to standard care, and lack of pragmatic barriers.
Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way (S-152), Seattle, WA 98108, USA; Department of Health Services, University of Washington, Boxes 357,660, 1959 NE Pacific St, Seattle, WA 98195, USA. Electronic address: Emily.Williams3@va.gov.
Emily C
EC
Williams
Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way (S-152), Seattle, WA 98108, USA. Electronic address: Jessica.Young@va.gov.
Jessica P
JP
Young
Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way (S-152), Seattle, WA 98108, USA; Primary and Specialty Medical Care Service, Veterans Affairs (VA) Puget Sound Health Care System - Seattle Division, 1660 S. Columbian Way, Seattle, WA 98108, USA. Electronic address: Carol.Achtmeyer@va.gov.
Carol E
CE
Achtmeyer
Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St, Bell Gateway Building, Toronto, ON M6 J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON M5 T 1R8, Canada; Department of Psychology, University of Toronto, 100 St. George Street, 4th Floor, Toronto, ON M5S 3G3, Canada. Electronic address: christian.hendershot@utoronto.ca.
Christian S
CS
Hendershot
D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000188:drug therapy* / Q000235:genetics*; D001291:Attitude of Health Personnel; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D000071185:Pharmacogenomic Testing; D010820:Physicians; D011320:Primary Health Care; D036301:Qualitative Research; D014481:United States; D014493:United States Department of Veterans Affairs
Alcohol use; Alcohol use disorders; Pharmacogenetics; Qualitative