Barriers and facilitators to the implementation of pharmacogenomic testing for antidepressants use in primary care: a systematic review using the consolidated framework for implementation research.

TL;DR

A systematic review of 13 qualitative and mixed-methods studies identified key barriers (limited perceived evidence, cost uncertainty, workflow disruption, low clinician confidence) and facilitators (perceived advantage, pharmacist support, interprofessional collaboration, reimbursement, training) to implementing pharmacogenomic-guided antidepressant prescribing in primary care.

Key findings

• Barriers to PGx-guided antidepressant implementation include insufficient perceived evidence of clinical utility, cost and reimbursement uncertainty, intervention complexity, and workflow disruption in primary care settings
• Facilitators include perceived relative advantage of PGx testing, pharmacist-led clinical support, interprofessional collaboration, established reimbursement models, clinical integration pathways, and structured provider training
• Implementation is currently constrained by interrelated systemic issues: limited clinical evidence perception, financial barriers, integration challenges into existing workflows, and underdeveloped implementation infrastructure
• The review used the Consolidated Framework for Implementation Research (CFIR) to systematically map determinants across individual clinician, organizational, and policy levels

Why this matters at the bedside

For practicing primary care physicians, this summary reveals that PGx-guided antidepressant prescribing faces organizational and systemic implementation barriers rather than purely clinical ones. Understanding these barriers—particularly workflow integration, cost concerns, and reimbursement clarity—is relevant to physicians considering adoption or advocating for institutional support of this testing approach.