2025 Southeastern Residency Conference

Title: Implementation of the Pharmacogenomic Testing for Veterans (PHASER) Program among High Suicide-Risk Veterans: A quality improvement project


Authors: Adirika Obiako, Christina Laird, Shari Brown, Tiffany Jagel


Objective: The primary objective of this quality improvement project is to increase testing and evaluate the impact of implementing PHASER in patients that are at a high risk of suicide who are on a mental health medication impacted by the PHASER panel.


Background: PHASER is an initiative designed to provide patients and providers access to high quality, evidence-based pharmacogenomic laboratory testing and recommendations that help optimize medication efficacy and reduce trial and error prescribing. The PHASER panel tests 15 different genes and multiple alleles that impact drug metabolism of over 73 commonly prescribed medications.


Methods: Patients flagged for a high risk for suicide have been identified from the High-Risk Flag Patient Tracking Report. Once these patients were identified, patients’ mental health medication regimen was reviewed to see if they were taking any mental health medications that were impacted by the PHASER testing panel. Patients on the high suicide risk dashboard were contacted and offered testing. Testing was ordered and scheduled for patients that were agreeable. Patients completed a one-time blood draw which was sent to a third-party testing facility where the test was performed and analyzed. Results were uploaded to patient medical records. The results highlight the type of metabolizer for each of the 15 genes and which of the 73 medications may require dose modification. Medications impacted were listed. When required, evidence-based dose adjustments were advised to prescribers based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. 


Results: 19.7% of candidates completed testing and their appointment with the pharmacogenomics pharmacist to review results for potential medication changes. Variants for cytochrome enzymes involved in pharmacogenomics influenced major depressive disorder medication metabolism were common. CYP2B6 and CYP2C19 had 53.6% variance present. CPY2D6 had 54% variance present. All of the patients included in the project had 1 of 3 cytochrome enzymes impacted and 51.3% who had 2 or more impacted. An average of 4.6 of the panel's 16 pharmacogenomic influenced major depressive disorder medications were impacted. 33.3% of patients had an actionable variant for a currently prescribed major depressive disorder medication and 20% required a pharmacogenomic guided dosage adjustment due to patient reported adverse drug event. These patients had been on their major depressive disorder medication for less than 3 months. 46.3% had been on major depressive disorder therapy for 3 months or more with no issues reported with adverse drug events or efficacy.

Conclusion: Definitive conclusions cannot be draw outside of the objective data reported, but some interesting parallels with what has been reported in the literature were noted. The literature reports Veterans carry at least 1 pharmacogenomic variant that can impact therapy decisions. We found these patients averaged 6 variants that impacted an average of 16 medications on the 73-medication panel. 1.6 of those variants were for a cytochrome enzyme involved in processing of pharmacogenomic influenced medications for major depressive disorder. Literature reports patients fail an average of 2-3 medications before finding symptom relief with depression. For 80% of the patients that completed testing this was true. These patients failed an average of 2.5 trials and this included pharmacogenomic influenced major depressive disorder medication trials only, it did not include trials for major depressive disorder medications that are not influenced by pharmacogenomics.