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you know, I would like I think a little more education –[that] would even be that more valuable for clinicians”. One participant wanted further training specific to results report interpretation. She (P03) asked for an explanation to detail: “Say, ‘here's the genes that we're going to be showing you, here are the ones that are relevant, here's what you tell the patients about these other ones that are irrelevant. And if you have trouble with this, you know, here's a resource for them and for you.’” Another physician (P09) volunteered: “Maybe even if someone just sat down and reviewed my results with me, that would give me an idea of how to present it to a patient, or how to explain it to a patient, if someone treated me like a lay-person and read through my results and showed me how they would do it”. Along with the various modes of trainings participants mentioned, they also were interested in receiving both provider and patient education materials. One participant (P09) example included: “I think for patients it would be nice if we had pamphlets, nice, colorful, good pamphlets, that we could put in the office that patients can grab and look at themselves, because that would help them initiate testing. I don't know how much having meetings and things like that will help, but definitely having a step-wise thing, how to order it. You know, ‘this is how to order. This is what you do with the results’.” A specific need mentioned by participants was potential changes in the results report to make it clearer. One participant (P03) said: ‘No, it [specific genetic/metabolic details] could all be on the back end of the report, but I need the first page to be much more clinically relevant”. One other area of need was regarding how to address PGx test cost (∼$400) and insurance coverage with participants. Currently, insurance does not cover most pharmacogenomic testing. One physician (P15) suggested: “Any additional info on helping those patients potentially get that test covered. Giving specific instructions, ideally printed, to say this is the cost, if it's not covered, what can you do to try to get it covered, or at least to be able to apply it to your insurance office, because that is the second primary question that most patients ask. Most will still balk at $400. I think $100 or $200, a lot more patients would come around to”. Discussion This report describes perspectives of primary care physicians in a community-based hospital system providing direct access PGx testing to their patients. Physicians expressed their views on the value and utility of PGx testing to help guide decision-making and improve patient outcomes. An important measure of the value of a genetics, or innovative, test is clinical utility [31]. However, when strong evidence is lacking, as in the case of some of the pharmacogenomics tests, incorporating key stakeholders’ perspectives, and the specific context, is helpful in determining current value of testing. Previous studies on views of the utility of PGx tests, from the perspective of primary care providers, have reported on value due to more accurate medication dispensing, decreasing adverse response to medications, improving medication effectiveness, and providing additional guidance for prescribing new medications [5,10]. According to another study, physicians found utility in providing PGx testing to improve patient outcomes by individualizing treatment to guide medication decisions and to decrease time and cost for maximizing the benefits of needed medications [35]. Utilizing PGx testing in order to avoid side effects from medication and improve medication effectiveness have been proposed as benefits in other studies as well. While many stakeholders have described the benefits and utility of PGx testing in terms of personalizing medication prescribing, our qualitative study revealed that participants had additional views of PGx test value and utility. For example, primary care physicians in this study broadened the more traditional concept of ‘clinical utility’ of PGx testing to include factors such as improving medication compliance, psychological reassurance for providers and patients, validation of and explanation for past medication experiences, increased patient autonomy and satisfaction, and benefit
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