Facilitators and Barriers to the Adoption of Pharmacogenetic Testing in an Inner-City Population
Facilitators and Barriers to the Adoption of Pharmacogenetic Testing in an Inner-City Population
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DOI：
10.1002/phar.2077
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发表时间：
2018-02-01
期刊：
影响因子：
4.1
通讯作者：
Nutescu, Edith A.
中科院分区：
文献类型：
--
作者：
Lee, Yee Ming;Manzoor, Beenish S.;Nutescu, Edith A.
目的调查城区居民对药物遗传检测的知识、态度和兴趣，主要目的是确定药物遗传检测的促进者和障碍；次要目标是确定患者对药物遗传检测感兴趣的预测因素以及患者愿意为测试支付多少费用。一项由19个问题组成的横断面调查亲自进行，以确定患者对药物遗传学测试的知识和意识，并收集人口统计学信息。在解释了药物遗传学后，患者对测试的兴趣进行了排名，并回答了引发药物遗传学测试的促进者和障碍的开放式问题，并阐明了患者愿意为测试支付多少钱。结果共调查了120名患者(平均年龄55.0-14.0岁，男性39.2%，非裔美国人69.2%)。促进者包括提供关于药物遗传测试的更多信息；详细说明测试对预测治疗效果的好处；患者对其提供者的信任，以做出正确的以基因为导向的处方决定；以及保险覆盖范围和测试负担能力。检测的障碍包括对检测结果的负面后果的担忧；检测过程的负担；老年人和那些药物有效的人感觉缺乏效用；隐私问题；以及对保险覆盖范围和检测负担能力的担忧。女性对药物遗传测试感兴趣的调整后几率高出4.2倍。几乎一半(44.4%)对测试感兴趣的患者愿意支付20美元或更多，而兴趣较低的患者中76.2%希望免费进行测试。结论本研究确定了促进因素(如提供额外的药物遗传学测试信息)和障碍(如感知结果的负面影响和测试效用)是让城市人口(主要是少数族裔)参与药物遗传学测试时需要解决的问题。女性性别是对药物遗传学测试感兴趣的预测因素。随着药物遗传测试在市中心人群中获得广泛应用，这些促进者和障碍应该得到考虑。
ObjectivesTo examine the knowledge, attitudes, and interest of an inner-city population toward pharmacogenetic testing, with the primary objective of identifying facilitators and barriers toward pharmacogenetic testing; and secondary objectives of determining predictors of patient interest in pharmacogenetic testing and how much patients would pay for the test.MethodsPatients were recruited from an Antithrombosis Clinic from March to April 2014. A cross-sectional 19-question survey was administered in person to determine patients' knowledge and awareness of pharmacogenetic testing and collect demographic information. After explaining pharmacogenetics, patients ranked their interest toward the test and answered open-ended questions that elicited facilitators and barriers toward pharmacogenetic testing and elucidated how much patients would pay for testing.ResultsA total of 120 patients (mean age 55.0 14.0 years, 39.2% male, 69.2% African American) were surveyed. Facilitators included providing further information about pharmacogenetic testing; elaborating on benefits of testing to predict treatment efficacy; patients' trust in their providers to make correct genotype-guided prescribing decisions; and insurance coverage and test affordability. Barriers to testing included concerns about the negative consequences associated with test results; burden of the testing process; perceived lack of utility among elderly and those whose medications were working; privacy issues; and concerns regarding insurance coverage and test affordability. Women had 4.2 times higher adjusted odds of being interested in pharmacogenetic testing. Almost half (44.4%) of the patients with high interest in the test were willing to pay $20 or more, whereas 76.2% of patients with low interest wanted testing at no cost.ConclusionThis study identified facilitators, such as providing additional pharmacogenetic test information, and barriers, such as perceived negative impact of the results and test utility, as issues to address when engaging an urban, largely minority population in pharmacogenetic testing. Female sex was a predictor of interest toward pharmacogenetic testing. These facilitators and barriers should be taken into consideration as pharmacogenetic testing gains widespread utility among inner-city populations.