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30% of physicians receiving the alert were inclined to make a change in prescription based on the specific alert, and in another study physicians reported disagreement about who should be responsible for receiving results and providing patient follow-up [10,20]. One new pharmacogenomics testing model that has not been investigated is direct access testing. This type of service utilizes provider-ordered PGx testing which involves mailing a testing kit to the patient and returning results in a manner that the provider typically uses (telephone, in-person, mail, etc.). Through this process, PGx testing can be completed at home by the patient, but still involves supervision from the ordering healthcare provider. This is distinct from direct-to-consumer testing where a healthcare provider does not need to be involved in the process [1,21–23]. Increased access to health information on the internet, demand for personal healthcare autonomy and lower test costs have likely increased the demand for these services – as healthcare has become more consumer-driven [22]. However, controversy remains regarding potential risks and benefits of consumer-driven access to genomic information [1,21,23]. Concerns have been raised such as individual misunderstanding and anxiety, potential use of unnecessary health services and acting on information without the input of a health professional [1,21,23]. Some studies have shown that only 25–35% of individuals report having shared their PGx direct-to-consumer test results with their physicians [1,24,25]. In one study, only 7% of physicians reported having seen a patient's direct-to-consumer test result [22]. These findings highlight an important communication gap between patients and their physicians. Direct access testing is a new concept to clinical PGx that aims to decrease this gap while maintaining patient autonomy. Very little is known about how primary care physicians view the use of direct access PGx services in their practices. Information is also lacking about how well prepared they feel in order to interpret test results that their patients receive from PGx testing. This paper reports on findings of a study to explore primary care physicians’ views of the utility and delivery of direct access to PGx testing in a community health system. Study participants were NorthShore University HealthSystem primary care physicians who received complimentary pharmacogenomics direct access kits through a pilot program. Physicians underwent PGx testing themselves and received results. They also received complimentary PGx kits for their patients. Once an order for PGx testing was placed, the direct access process included watching an online educational video, completing a requisition form and buccal swab at home and mailing in the sample to the laboratory Results were sent by mail to both the participating physicians and their patients who had complimentary testing. PGx test results were also available to the physician in the EMR. The intent of the pilot program was to increase physician understanding of the direct access process as well as PGx in general. NorthShore University HealthSystem is a four-hospital community health system in north suburban Chicago with over 100 physician offices. A purposive sampling plan included identification of pilot program primary care physicians practicing in a range of practice settings and locations in the health system. Participants were recruited by email from six primary care practice pilot sites located in the service area. Participants received compensation for their time with a $150 service award. This study was reviewed and approved by NorthShore University HealthSystem's institutional review board. Qualitative semi-structured interviews were chosen as a method of eliciting data from participants – to allow for clarification of viewpoints, discovery of unanticipated findings and as a strategy to learn more about the rationale behind primary care physician PGx clinical decision-making. Audiotaped individual interviews were conducted during December 2016 and January 2017. The interviews lasted approximately 30 min each and were conducted in-person at the primary care practice site or via

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