Garry M. Silvey

Factors Influencing Uptake of Pharmacogenetic Testing in a Diverse Patient Population

Background: The successful integration of pharmacogenetic (PGx) testing into clinical care will require attention to patient attitudes. In this study, we aimed to identify the major reasons why patients would or would not consider PGx testing and whether these factors differed by race, socioeconomic and insurance status, and medical history. Methods: We developed and conducted a survey within the adult patient population of the Duke Family Medicine Center. Results: Of 75 completed surveys (65% African-American), 77% indicated they were ‘very likely’ or ‘somewhat likely’ to take a PGx test. Respondents who had experienced a side effect were significantly more likely to indicate they would take a PGx test and expressed greater interest in learning more about testing than those who had not. Drug safety and effectiveness were the major reasons to have PGx testing. Privacy concerns and lack of insurance coverage for testing were the major reasons to decline testing. Conclusions: We found no differences in interest in PGx tests by race or socioeconomic status, but found stronger interest from those with a history of side effects and private insurance. While the overall support of PGx testing is encouraging, greater reassurance of medical privacy and development of educational resources are needed.

A randomized clinical trial of clinical decision support in a rural community health network serving lower income individuals: study design and baseline characteristics.

Lower income individuals in the US frequently experience difficulties in obtaining access to needed health care services. We describe a randomized clinical trial that seeks to improve the quality of, and access to healthcare services for medically underserved populations in five rural counties of North Carolina. We propose to achieve these improvements by implementing system-to-system integration via a telehealth network with an asynchronous clinical decision support system for health care providers.

Clinical and economic results from a randomized trial of clinical decision support in a rural health network.

BACKGROUND Replication studies evaluate technologies in usual use settings. METHODS We conducted a clinical trial to determine whether reductions in clinical and economic results observed in a previous study could be replicated in a larger setting. Subjects were randomized to receive intervention (email notifications for sentinel health events sent to their care managers) or control. MAIN OUTCOME MEASURES The primary outcome was the rate of emergency department visits for low severity conditions. Secondary outcomes included: medical costs and other clinical event rates. RESULTS We randomized 13,454 individuals (intervention, 6740; control, 6714). Subjects in both groups had similar rates of clinical events and medical costs. CONCLUSION The use of email notifications to care managers was associated with no reductions in clinical events or medical costs.