Considerations for the Reimbursement of Pharmacogenomic Testing in Ontario Psychiatry
Despite incredible advances in the neurosciences and psychological sciences, many of the most essential operations of the human brain remain enigmas. Among these mysteries are the precise ways in which many medications, especially those used to treat mental illnesses, or, ‘psychotropics’, affect the brain, body, and behaviour of humans. Consequently, many psychiatrists, as well as physicians in other clinical disciplines, adopt a ‘trial-and-error’ approach to prescribing medications. Trial-and-error combines the physician’s professional experience with their knowledge of existing medications and standards of care to determine the most appropriate medication for a given patient. Thereafter, physicians adjust the dose of the medication — or, in many cases, alter the prescription, itself — based on the patient’s response thereto (Mrazek, 2010). Medication trials stop either when the patient is deemed to be a ‘non-responder’ or when intolerable side effects occur.
The GeneSight test was developed initially to translate knowledge regarding genotype-phenotype relationships and their effects on individual response to medication for the improvement of psychiatric patient care. Due to insufficient funding, translational progress has been halted. There is opportunity to resume progress toward knowledge translation and implementation of regulated pharmacogenomic testing via the completion of a patient needs assessment. In the healthcare context, a needs assessment is a systematic approach to determining the health needs of a given population and determining the most efficient and effective way to meet them (Wright, Williams, & Wilkinson, 1998; Australian Institute of Family Studies, 2019). Completion of a patient needs assessment will allow the IMPACT research team to understand the legitimate needs of psychiatric patients with regard to pharmacogenomic testing. In turn, this will allow them to develop an implementation strategy that addresses these needs directly.
Capstone Advisory Committee:
TRP Faculty Lead:
Dr. Joseph Ferenbok