Clinician Satisfaction With Pharmacogenomics Clinical Services at a Multistate Health System

ABSTRACT

Pharmacogenomics (PGx) utilizes genetic information to optimize medication management. Barriers to PGx implementation include limited confidence and knowledge in applying results, time constraints, and financial barriers. Clinical services across health systems vary greatly with differing consultative PGx service models. Most research on clinicians and PGx has been centered around attitudes and perspectives, with limited data regarding clinician satisfaction with PGx clinical services. An internally developed survey was created to assess clinician satisfaction with PGx services across a single health system. A survey was deployed to 645 clinicians (physicians, advanced practice providers, and genetic counselors) who utilized PGx clinical services (ordered PGx testing or a referral to the PGx clinic) within the past 3 years. Surveys were distributed via secure email in June 2025. A total of 36 out of 645 clinicians participated in the survey, which is noted as a limitation. Respondents tended to be satisfied (“somewhat satisfied” or “very satisfied”) across several clinical service domains (e.g., process of ordering PGx testing, integration into the electronic health record, and return of PGx results). Pharmacist notes and clinical decision support yielded the highest satisfaction. Most clinicians reported PGx results have positively impacted patient outcomes. Nearly half of respondents noted experiencing barriers in explaining PGx results to patients. The PGx clinic may help mitigate barriers in explaining PGx results to patients. Overall, responding clinicians were satisfied with the majority of PGx clinical services.

Study Highlights

• What is the current knowledge on the topic?

  • ○
    Existing literature has focused on clinician attitudes and perspectives toward pharmacogenomics (PGx); however, data regarding clinician satisfaction with PGx clinical services is limited.
• What question did this study address?

  • ○
    The study evaluated elements of satisfaction and identified opportunities to enhance PGx clinical services and clinician experiences.
• What does this study add to our knowledge?

  • ○
    Despite a low response rate, clinicians' feedback highlights the value of PGx services such as PGx pharmacist notes and clinical decision support (CDS). Concise standard note templates enhance clarity and actionability to PGx recommendations. CDS stewardship is essential to harness clinician support and satisfaction.
• How might this change clinical pharmacology or translational science?

  • ○
    Findings may inform optimization of PGx clinical service models, which could support more individualized prescribing in routine care.

1. Introduction

Pharmacogenomics (PGx) contributes to a precision medicine approach by incorporating genetics as a part of the medication use process. Clinician attitudes about PGx and its utility vary. Many clinicians recognize how PGx can aid in medication selection; however, they are hesitant to use PGx in their practice [1]. Hesitations, in part, stem from limited knowledge and confidence with PGx results, in addition to time and financial barriers [2, 3]. Collaborating with pharmacists and other key healthcare personnel can help address barriers. Pharmacists can help with interpreting test results and providing recommendations to clinicians. Additionally, pharmacists play a key role in interdisciplinary precision medicine care through their ability to educate patients, thus providing the patient with needed tools to work with their clinicians and participate in their own care.

The adoption of PGx clinical services differs widely across health systems. Overall implementation remains limited; several consultative service models have been explored. A study by Desai and colleagues examined PGx consult notes found that clinicians desire concise and easy to follow information [4]. Pharmacists are key personnel for providing clear and succinct PGx interpretation and recommendations for clinicians [5]. The majority of literature surrounds clinician attitudes and perspectives toward PGx. However, data regarding clinician satisfaction with PGx services is limited. Clinicians were hypothesized to be highly satisfied with PGx pharmacist notes and clinical decision support (CDS). The primary objective of our study was to evaluate clinician satisfaction and identify opportunities to enhance clinician experiences with PGx clinical services.

2. Methods

2.1. Setting

Sanford Health is a large rural healthcare system spanning the upper Midwest, comprising four main regions: Bemidji, MN, USA, Bismarck, ND, USA, Fargo, ND, USA, and Sioux Falls, SD, USA. Sanford Health's precision medicine initiative, Sanford Imagenetics, was created in 2014 with the aim of integrating precision medicine into primary care [6, 7]. Sanford Imagenetics is a multi‐disciplinary team consisting of physicians, clinical pharmacists, genetic counselors, laboratory personnel, clinical informatics, and data analysts. In the current state, six pharmacists are part of the PGx team. PGx testing has been an integral part of the Imagenetics initiative and has evolved substantially since its origination. Mandated clinician education was deployed to all clinicians during the early stages of program development. Clinician education is currently offered; however, not required for all clinicians [7]. Any clinician may place an order for PGx testing as single gene or panel‐based testing through the electronic health record (EHR) without prior authorization unless deemed necessary by individual insurance companies. In the current state, there are no pre‐test alerts to facilitate PGx testing based on specific medications; however, indication‐specific CDS has been utilized [8, 9]. All PGx results are reviewed by a PGx pharmacist and interpretation is provided via a clinical note in the EHR [10, 11, 12]. Internal PGx testing is encouraged to facilitate pharmacist comprehensive review and automated deployment of CDS. However, external PGx testing may be utilized based on clinician discretion.

Panel based testing is currently comprised of 14 or 16 genes (ABCG2, CYP2B6, CYP2C cluster, CYP2C19, CYP2C9, CYP2D6, CYP3A5, CYP4F2, DPYD, HLA‐B*57:01, NUDT15, SLCO1B1, TPMT, VKORC1 with optional G6PD and UGT1A1) [13]. PGx testing has been conducted by an in‐house College of American Pathologists (CAP) accredited/Clinical Laboratory Improvements Amendments (CLIA) certified molecular medical genetics laboratory since inception while the testing platform has advanced from single nucleotide polymorphism (SNP) to targeted next generation sequencing (tNGS). tNGS is short read sequencing that utilizes oligo‐directed digested capture and amplification of target regions using genomic DNA as starting template material. CYP2D6 copy number variation (CNV) is assessed at two distal sites (intron 2 and exon 9) via droplet digital PCR technology. With SNP testing, turnaround time (defined as sample receipt to result reporting) was on average 4.1 days, whereas the turnaround time for tNGS is typically 10 days [14].

In brief, the clinical services offered by the Imagenetics program encompass the PGx clinic, pharmacist review of all PGx results accompanied by a clinical note within the EHR, and post‐test CDS [6, 7, 9, 10, 11]. PGx resources within the EHR for clinicians are multifaceted to include drug‐gene specific education tailored to patients, genomic indicators to outline potential impacted medications based on genetic variants (both patient and clinician facing), result PDF outlining genetic variants detected and interpretation of results with medication dosing guidance, and alerts upon medication prescribing [9]. To date, over 35,000 PGx pharmacist notes have been completed. Pharmacists deploy patient portal messages following pharmacist interpretation of PGx results [15]. In the spring of 2022, a PGx clinic was implemented aiming to offer access to a PGx specialist for adults [11]. Clinic visits focus on patient education and outlining PGx testing benefits, limitations, and enhancing understanding of PGx results. Patients can be referred by a clinician or may contact the PGx clinic directly to schedule an appointment. Pre‐ and post‐test visits are offered either in‐person or virtually. Appointments are scheduled for 60 min and include an in‐depth clinical note inclusive of patient reported information routed to the referring clinician outlining PGx interpretation, recommendations, and relevant findings.

A cross‐sectional, anonymous, electronic survey of clinicians in a single health system was developed to assess clinician experiences with PGx clinical services. This study was deemed not human research by the Sanford Health Institutional Review Board (STUDY00003936).

2.2. Survey Participants

A list of all Sanford Health clinicians (physicians, genetic counselors, or advanced practice providers) regardless of specialty who have ordered PGx testing or placed a PGx clinic referral was abstracted from the EHR. Participants were clinicians who utilized PGx clinical services including PGx testing and/or PGx clinic visits (e.g., referrals, pre and/or post clinic visits) within the past 3 years. External clinicians utilizing Sanford Medical Genetics Laboratory for PGx testing (e.g., reference lab only) were excluded based on job code. A total of 645 clinicians were invited to participate in the survey. Clinician demographics (age, years in practice, specialty, and training) were abstracted.

2.3. Survey Development

The goal of this survey was to generate questions that could elicit clinician satisfaction and feedback on all aspects of PGx clinical services at Sanford Health. Three PGx pharmacists worked with representatives of Sanford Health's Market Research and Data Science teams to create a descriptive survey. The survey spanned five general themes: clinician satisfaction with PGx services, utilization patterns, knowledge and comfort levels, value and impact of PGx testing, and barriers. Questions to gauge satisfaction surrounded the process of ordering PGx tests and PGx clinic referrals, receiving PGx test results, and availability of clinic visits (in‐person vs. virtual visits). The survey utilized a 5‐point Likert scale ranging from “very dissatisfied” to “very satisfied.” Surveys (Qualtrics, UT, USA) were reviewed and approved by the Survey Committee and Chief Physicians Committee. The survey comprised 28 multiple‐choice questions, matrix tables, and open‐ended questions (Table S1).

2.4. Survey Deployment

Surveys were distributed via secure email to 645 clinicians in June 2025. The email invitation to participants described the purpose of the survey and estimated time for survey completion of 7–10 min. Respondents who had not completed the survey received 2 reminder emails after distribution and were given a total of 6 weeks for completion. Participants were not required to answer all questions, and partial responses were captured. Participation was voluntary, and responses were confidential.

2.5. Analysis

Analyses were restricted to descriptive statistics. Partial responses were analyzed on a per question basis. Post hoc analysis suggested that binning “very dissatisfied” and “somewhat dissatisfied” as well as “somewhat satisfied” and “very satisfied” made for less complicated interpretation. All data were analyzed using R version 4.3.2. Given low clinician response rates, psychometric properties were not investigated.

3. Results

A total of 36 clinicians from across all four regions of Sanford Health participated in the survey. Respondents had a median age of 46 years and 67% were female (Table 1). Participants had a median of 12 years of practice experience. Specialties varied widely; however, most respondents were family and internal medicine clinicians (n = 25, 69%).

TABLE 1.

Clinician demographics.

Characteristics	N = 36 a
Age	46 (39, 63)
Gender
Female	24 (67%)
Male	12 (33%)
Please provide your number of years in practice	12 (8, 26)
Region
Bemidji	3 (8.3%)
Bismarck	3 (8.3%)
Fargo	15 (42%)
Sioux Falls	15 (42%)
Specialty
Cardiology	1 (2.8%)
Children's	2 (5.6%)
Family and internal medicine	25 (69%)
Hospitalist	1 (2.8%)
Oncology	2 (5.6%)
Psychology	1 (2.8%)
Virtual care	1 (2.8%)
Women's	3 (8.3%)

^a Median (Q1, Q3); n (%).

3.1. Clinician Satisfaction With PGx Clinical Services

Respondents tended to be satisfied (“somewhat satisfied” or “very satisfied”) across several domains: process of ordering PGx tests (64%), turnaround times (62%), method of returning PGx results (65%), clinical notes provided by PGx pharmacists (79%), available EHR PGx resources (74%), and current methods of returning results to patients (59%) (Table 2). However, the process of placing a referral to the PGx clinic and availability of PGx clinic visit types (both in‐person or virtual) were more commonly reported as “neither satisfied nor dissatisfied” 53% versus 74%, respectively.

TABLE 2.

Clinician satisfaction with pharmacogenomics (PGx) clinical services.

Please select your level of satisfaction with the following statements	Very dissatisfied	Somewhat dissatisfied	Neither satisfied nor dissatisfied	Somewhat satisfied	Very satisfied
Process of ordering Sanford pharmacogenomics (PGx) tests	1 (2.8%)	3 (8.3%)	9 (25%)	14 (39%)	9 (25%)
Current turnaround time for receiving PGx test results	1 (2.9%)	6 (18%)	6 (18%)	9 (26%)	12 (35%)
Current method of returning PGx test results	2 (5.9%)	5 (15%)	5 (15%)	9 (26%)	13 (38%)
Clinical notes provided by the PGx pharmacists	1 (2.9%)	3 (8.8%)	3 (8.8%)	9 (26%)	18 (53%)
Available electronic health record PGx resources (genomic indicators, alerts)	1 (2.9%)	3 (8.8%)	5 (15%)	10 (29%)	15 (44%)
Current method of returning PGx test results to patients	3 (8.8%)	4 (12%)	7 (21%)	10 (29%)	10 (29%)
Process of placing a referral to the PGx clinic	0 (0%)	3 (8.8%)	18 (53%)	7 (21%)	6 (18%)
Visit types (video visit vs. in‐person) provided by the PGx clinic—in‐person visits	0 (0%)	0 (0%)	25 (74%)	4 (12%)	5 (15%)
Visit types (video visit vs. in‐person) provided by the PGx clinic—video visits	0 (0%)	0 (0%)	25 (74%)	5 (15%)	4 (12%)

Note: N = 36 participants, however, partial responses were captured.

3.2. Utilization Patterns

Over a 3‐year period, the median number of PGx testing orders amongst survey participants was 7 and the median number of referrals to PGx clinic was 1 (Table 3). PGx testing was patient‐driven for 56% of all orders. PGx testing was often reactive (69%) as compared to preemptive (31%). External PGx testing was ordered at least once by 22% of all surveyed clinicians, whereby the frequency tended to be either monthly (n = 3, 38%) or yearly (n = 3, 38%). Twenty clinicians noted that patients brought direct‐to‐consumer tests or PGx test results ordered by another provider to their clinic visits. Half of clinicians reported receiving external PGx test results about once per year.

TABLE 3.

Utilization patterns.

Characteristics	N = 36 a
PGx orders	7 (2, 14)
Referrals	1.0 (0.0, 2.0)
On average when ordering PGx testing, is it primarily provider or patient driven?
Patient driven	20 (56%)
Provider driven	16 (44%)
On average when ordering PGx testing is it primarily reactively (after medication failure/side effects) or preemptively (prior to medication failure or trial)?
Preemptively	11 (31%)
Reactively	25 (69%)
Have you ever ordered external PGx testing?
Yes	8 (22%)
No	28 (78%)
How often have you ever ordered external PGx testing?—selected choice
Once	1 (13%)
Monthly	3 (38%)
Yearly	3 (38%)
Other (please specify) b	1 (13%)
Has a patient ever brought PGx test results to a visit with you, including either direct‐to‐consumer tests or PGx tests ordered by another provider?	20 (59%)
How frequently has a patient ever brought PGx test results to a visit with you?—selected choice
Once	3 (15%)
Monthly	4 (20%)
Yearly	10 (50%)
Other (please specify) c	3 (15%)

^a Median (Q1, Q3); n (%).

^b Free text response included: 1 participant responded every 2 weeks.

^c Free text response included: 1 participant responded 3 times a year; 1 participant responded less than once per year; 1 participant responded bi‐monthly.

3.3. Knowledge and Comfort Levels

Of all respondents, 69% stated that they “somewhat agree” with the statement that they “know how to clinically apply PGx knowledge” whereas 17% stated that they “strongly agree” (Table 4). Similarly, 53% reported that they are “somewhat comfortable” incorporating PGx information into clinical decision‐making, while 25% stated that they are “very comfortable.” Of all respondents, 39% reported having received some training or education in PGx. Of those that had received training and/or education, 5 (36%) respondents reported that this training and/or education was mandated and provided by Sanford Health. When surveyed about interest in training or education opportunities, clinicians favored a clinic meeting with PGx pharmacists (67%), followed by online learning modules (57%) as preferred education methods.

TABLE 4.

Knowledge and comfort levels.

Characteristics	Overall N = 36 a	Family and internal medicine N = 25 a	Specialty N = 11 a
How much do you agree with the following statement? I know how to clinically apply PGx knowledge?
Strongly disagree	1 (2.8%)	1 (4.0%)	0 (0%)
Somewhat disagree	3 (8.3%)	2 (8.0%)	1 (9.1%)
Neither agree nor disagree	1 (2.8%)	1 (4.0%)	0 (0%)
Somewhat agree	25 (69%)	19 (76%)	6 (55%)
Strongly agree	6 (17%)	2 (8.0%)	4 (36%)
How comfortable are you with incorporating PGx information into your clinical decision‐making?
Very uncomfortable	1 (2.8%)	1 (4.0%)	0 (0%)
Somewhat uncomfortable	4 (11%)	2 (8.0%)	2 (18%)
Neither comfortable nor uncomfortable	3 (8.3%)	3 (12%)	0 (0%)
Somewhat comfortable	19 (53%)	13 (52%)	6 (55%)
Very comfortable	9 (25%)	6 (24%)	3 (27%)
Have you received any training or education in PGx? b	14 (39%)	11 (44%)	3 (27%)
Was the training or education mandated by Sanford? b	5 (36%)	5 (45%)	0 (0%)
Please indicate your level of interest in the following opportunities to learn more about applying PGx testing to patient care—online learning module
Very uninterested	4 (12%)	3 (13%)	1 (10%)
Somewhat uninterested	3 (9.1%)	2 (8.7%)	1 (10%)
Neither interested nor uninterested	7 (21%)	4 (17%)	3 (30%)
Somewhat interested	11 (33%)	9 (39%)	2 (20%)
Very interested	8 (24%)	5 (22%)	3 (30%)
Please indicate your level of interest in the following opportunities to learn more about applying PGx testing to patient care—grand rounds
Very uninterested	4 (12%)	3 (13%)	1 (10%)
Somewhat uninterested	6 (18%)	3 (13%)	3 (30%)
Neither interested nor uninterested	9 (27%)	6 (26%)	3 (30%)
Somewhat interested	11 (33%)	9 (39%)	2 (20%)
Very interested	3 (9.1%)	2 (8.7%)	1 (10%)
Please indicate your level of interest in the following opportunities to learn more about applying PGx testing to patient care—clinic meeting with PGx pharmacists
Very uninterested	3 (9.1%)	1 (4.3%)	2 (20%)
Somewhat uninterested	0 (0%)	0 (0%)	0 (0%)
Neither interested nor uninterested	8 (24%)	4 (17%)	4 (40%)
Somewhat interested	17 (52%)	15 (65%)	2 (20%)
Very interested	5 (15%)	3 (13%)	2 (20%)
Please indicate your level of interest in the following opportunities to learn more about applying PGx testing to patient care—emailed information
Very uninterested	4 (12%)	3 (13%)	1 (10%)
Somewhat uninterested	4 (12%)	2 (8.7%)	2 (20%)
Neither interested nor uninterested	10 (30%)	5 (22%)	5 (50%)
Somewhat interested	13 (39%)	12 (52%)	1 (10%)
Very interested	2 (6.1%)	1 (4.3%)	1 (10%)

^a n (%).

^b Denotes participants who responded yes.

3.4. Value and Impact of PGx Testing

The majority of participants (75%) found PGx results were either “somewhat helpful” or “very helpful” in managing their patient's health (Table 5). Furthermore, 70% of clinicians reported that they “somewhat agree” or “strongly agree” that PGx testing positively impacted patient outcomes in their practice. Similarly, 70% of respondents reported that they “somewhat agree” or “strongly agree” that PGx testing has improved their ability to personalize treatment decisions.

TABLE 5.

Value and impact of pharmacogenomics (PGx) testing.

Characteristics	N = 36 a
How helpful do you think PGx results would be for managing your patient's health?
Very unhelpful	1 (2.8%)
Somewhat unhelpful	4 (11%)
Neither helpful nor unhelpful	4 (11%)
Somewhat helpful	22 (61%)
Very helpful	5 (14%)
How likely are you to recommend the PGx clinic to your colleagues?
Very unlikely	3 (8.8%)
Somewhat unlikely	2 (5.9%)
Neither likely nor unlikely	8 (24%)
Somewhat likely	14 (41%)
Very likely	7 (21%)
How likely are you to recommend PGx testing to your colleagues?
Very unlikely	3 (9.1%)
Somewhat unlikely	4 (12%)
Neither likely nor unlikely	2 (6.1%)
Somewhat likely	16 (48%)
Very likely	8 (24%)
Please select your level of agreement with the following statements—PGx testing has positively impacted patient outcomes in my practice
Strongly disagree	2 (6.1%)
Somewhat disagree	2 (6.1%)
Neither agree nor disagree	6 (18%)
Somewhat agree	15 (45%)
Strongly agree	8 (24%)
Please select your level of agreement with the following statements—PGx testing has improved my ability to personalize treatment decisions
Strongly disagree	3 (9.1%)
Somewhat disagree	0 (0%)
Neither agree nor disagree	7 (21%)
Somewhat agree	15 (45%)
Strongly agree	8 (24%)

^a n (%).

3.5. Barriers

Nearly half (47%) of all respondents reported having experienced barriers in explaining PGx test results to patients (Table 6). Lack of clinician training and education, patient education and understanding, and applicability of PGx results emerged as themes for barriers. Of those clinicians who reported experiencing barriers with PGx, 21% reported that a lack of in‐person PGx clinic appointments was a barrier. Of all respondents, 59% stated that they were “somewhat likely” or “very likely” to consult a PGx‐trained pharmacist for assistance interpreting test results.

TABLE 6.

Perceived barriers.

Characteristics	N (%)
Have you experienced any barriers in explaining PGx test results to patients?
Yes	16 (47)
No	18 (53)
How likely are you to consult a PGx‐trained pharmacist for assistance interpreting test results?
Very unlikely	4 (12)
Somewhat unlikely	5 (15)
Neither likely nor unlikely	5 (15)
Somewhat likely	11 (32)
Very likely	9 (26)
Do you find lack of in‐person appointments to be a barrier?
Yes	7 (21)
No	27 (79)

Note: N = 36 participants, however, partial responses were captured.

4. Discussion

This study found that clinicians are satisfied with the majority of PGx clinical services at a single healthcare system. However, the low survey response rate limits the generalizability of these findings and responses may have been skewed toward those with strong opinions on PGx services. The highest satisfaction was reported with PGx pharmacists' clinical notes. Every PGx result is reviewed by a PGx pharmacist, and a clinical note is entered within the EHR providing interpretation and patient specific clinical recommendations [12]. While resource intensive, this study reinforces the value of real‐time pharmacist evaluation of PGx results. High clinician satisfaction with pharmacist notes is consistent with literature across many specialties [16, 17, 18, 19, 20]. A challenge with clinical notes is finding the balance for standardization while allowing customization based on prescriber preferences. Desai and colleagues identified clinicians' desired differing documentation for active versus potential drug‐gene interactions [4]. Complex clinical scenarios, such as those involving phenoconversion, may be more difficult to explain and require additional information. To further enhance clinician satisfaction, a comprehensive review and update of note templates was completed to enhance clarity and conciseness of PGx recommendations. Future work entails evaluating acceptance rates of PGx recommendations to clinicians via notes.

Participants also expressed high satisfaction with CDS tools; however, this study did not quantify the frequency of clinician interaction with CDS tools. The high level of satisfaction with CDS may be attributed to stewardship efforts. The majority of PGx CDS evaluations focus on alert acceptance and/or override as a proxy for user satisfaction. While not specific to PGx, a study by Gallo and colleagues reported that 79% of clinicians had positive responses toward the curation of an alert to minimize risk for torsades de pointes [21]. At our institution, a PGx pharmacist performs annual reviews and validations of PGx CDS supplemented by ad hoc reviews as new literature becomes available [9]. Clinicians can also provide real‐time feedback on CDS alerts, which is actively monitored by a PGx pharmacist. Ongoing CDS maintenance evaluates acceptance and alignment with PGx recommendations [8, 22, 23, 24, 25]. Clinicians were educated and encouraged to provide real‐time feedback on alerts and PGx services.

Other domains where the majority of clinicians reported satisfaction included the method of returning PGx results to clinicians and patients, process of ordering PGx tests, and turnaround times. Clinicians expressed less satisfaction with the process of returning PGx results to patients compared to the workflow of returning results to prescribers. Following the closure of the survey response period, clinician education sessions were conducted across the health system to highlight survey findings and provide an opportunity for discussion of PGx services. Collateral materials were distributed to reinforce the process for ordering PGx testing and mechanisms for PGx support. Optimal strategies to empower patients in understanding their results and the impact on medications are still being defined. The return of PGx results has previously been identified as a barrier. Therefore, the PGx team implemented patient messaging upon the return of results [15]. Several studies have been conducted to evaluate patient satisfaction and understanding of PGx results using a variety of approaches from patient‐centered results reports to literacy assessments [13, 26, 27, 28, 29, 30].

Clinicians reported being neither satisfied nor dissatisfied with the availability of PGx clinic appointment types and the process of placing PGx referrals. Of note, not all participants placed a referral to the PGx clinic; therefore, perpetuating the potential for response bias. A study by Maska and colleagues found patients were highly satisfied with a multidisciplinary PGx clinic, which is consistent with our previous analysis [13, 31]. An initial lack of virtual appointment availability around the time of the clinic implementation may have contributed to decreased clinician satisfaction. However, virtual appointments were rapidly deployed to better serve our rural patient population. Lack of in‐person appointments was reported as a barrier to explaining PGx results by 21% of clinicians. The workflow for placing a PGx clinic referral was reinforced through clinician education sessions outlining that a separate clinical note would be provided with a more detailed recommendation encompassing patient‐reported information. Future research is warranted on preference for PGx clinic appointment types from both clinician and patient perspectives to enhance satisfaction.

A majority of responding clinicians reported that PGx testing has improved their ability to personalize treatment decisions; however, in a study by Johengen and colleagues, the majority of respondents did not feel confident in their ability to interpret PGx results [32]. Sperber and colleagues explored the concepts of quality, population health, and cost in relation to PGx through qualitative interviews with prescribers [33]. They found prescribers did not see PGx as an advantage when compared to the current trial and error approach, although PGx could be used to increase confidence and help with patient buy‐in for medication selection. Cost was a major barrier identified as a reason prescribers were cautious of using PGx. Additionally, clinicians have reported not feeling qualified to discuss results and implications, thus highlighting the need for pharmacists to integrate PGx into clinical practice [34]. Despite the low response rate to this survey, previous work conducted at Sanford Health identified primary care providers found PGx testing more useful than specialty providers [35]. The majority of participants within the current study were primary care providers. Robust education increased clinician comfort in ordering PGx tests for both primary care and specialty clinicians [35]. Enhancing awareness and utilization of the PGx clinic may serve as a valuable resource for mitigating barriers to result interpretation, thereby facilitating increased management of patient health and positive impact on patient outcomes. PGx case‐based education sessions are planned for physician grand rounds to further emphasize clinicians' ability to personalize treatment. Future research endeavors include investigation of clinical outcomes on drug‐gene pairs to further reinforce the applicability of PGx in clinical care.

4.1. Limitations

The survey response rate was small, which is often a limitation in survey research. This may have limited the generalizability of the findings as responses captured may not fully represent the perspectives of the broader clinician population. Survey participation was confined to a single health system. Furthermore, clinician PGx utilization patterns were low, which may have influenced results. Survey responses were limited to Sanford Health clinicians who utilized Imagenetics' PGx services within the past 3 years. Locum clinicians as well as external clinicians using Sanford PGx testing as a reference lab were excluded from the survey. The response rate was low; however, it was comparable to other clinician surveys within the health system. The lack of response may be attributable to sender credentials, as the survey was issued by a pharmacist rather than a physician. Additionally, factors that may have led to a low response rate include the length of the survey and clinician burden. The initial premise of Sanford Imagenetics, merging genetics into primary care, meant that most clinicians who completed this survey were internists or family medicine clinicians. Given the lack of diversity in clinician specialty, the results limit the generalizability. Some clinicians may have completed Sanford Health mandated PGx training modules early during program development, which may have influenced opinions and comfortability with interpreting and incorporating PGx. Clinicians who have not used PGx clinical services were not surveyed, which may have limited the identification of barriers to utilizing PGx clinical services. PGx program structure varies across healthcare systems; therefore, results may not be generalizable across all regions within the health system or to other PGx programs. However, limited literature has been published surrounding clinician satisfaction with PGx services; therefore, this work provides a foundation for future PGx satisfaction research.

Author Contributions

K.J., N.J.P., M.W., E.W., and A.M. wrote the manuscript; K.J., N.J.P., M.W., E.W., and A.M. designed the research; K.J., N.J.P., M.W., E.W., and A.M. performed the research; M.W. analyzed the data.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: cts70520‐sup‐0001‐Supinfo.docx.