Barriers and facilitators to the implementation of pharmacogenomic testing for antidepressants use in primary care: a systematic review using the consolidated framework for implementation research.

Pharmacogenomic (PGx) testing may improve antidepressant prescribing, but uptake in primary care is limited. The Consolidated Framework for Implementation Research (CFIR) can help identify determinants of implementation. To synthesise barriers and facilitators to implementing PGx-guided antidepressant prescribing in primary care using CFIR, we searched MEDLINE, EMBASE, Scopus, CINAHL, APA PsycINFO, and Web of Science to March 2025. Qualitative and mixed-methods studies were screened by two independent reviewers and analysed using a CFIR-informed framework. Thirteen studies (n = 979 records screened) involving clinicians, administrators, policymakers, and patients were included. Barriers included limited perceived evidence, cost and reimbursement uncertainty, intervention complexity, workflow disruption, and low clinician confidence. Facilitators included perceived relative advantage, pharmacist-led support, interprofessional collaboration, reimbursement, clinical integration, adaptable delivery models, and training. Our findings suggest that PGx testing is viewed as promising in primary care, but implementation is constrained by interrelated issues of clinical utility, cost, workflow integration, and immature implementation processes.