Pharmacogenetic Testing Among Home Health Patients | NCT02378220

NCT02378220

Status Module

Name	Class
Harding University	OTHER

Description Module

Conditions Module

Arms/Interventions Module

Arm Groups

Label	Type	Description	Intervention Names
Controls ("not tested")	No Intervention	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
Intervention ("tested")	Active Comparator	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug interactions (DDI), drug-gene interactions (DGI), and drug-drug-gene interactions (DDGI) using YouScript® to provide drug therapy recommendations to prescribers.	Genetic: Pharmacogenetic testing

Name	Type	Description	Arm Group Labels	Other Names
Pharmacogenetic testing	Genetic	Pharmacogenetic testing via YouScript® Personalized Prescribing System	Intervention ("tested")

Outcomes Module

Primary Outcomes

Measure	Description	Time Frame
Number of Re-hospitalizations at 30 and 60 Days	The primary outcomes included the number of re-hospitalizations at 30 and 60 days.	30 days, 60 days post discharge
The Primary Outcomes Included the Number of Emergency Department Visits at 30 and 60 Days.	Assessed the number of Emergency Department visits at 30 and 60 days post discharge with pharmacogenetic testing and YouScript® Personalized Prescribing system.	30 days, 60 days post discharge

Secondary Outcomes

Measure	Description	Time Frame
Time to 1st Re-hospitalization	To assess time to first re-hospitalization, we compared the exploratory time-to-event outcomes between the tested and untested groups at 30 days and 60 days. These outcomes were measured using cumulative percentage events at 30 and 60 days, referring to the percentage of subjects re-hospitalized before or at 30 and 60 days.	30 days, 60 days

Eligibility Module

Eligibility Criteria

Inclusion Criteria:

Age 50 or older.
Willing and able to provide informed consent for study participation either directly or by a legally authorized representative (LAR).
Presently taking or beginning treatment with at least one of the following oral forms of medication (excluding medications taken PRN) (generic name given with major U.S. brand name given in parentheses). These medications are subject to significant drug-gene interactions as defined by FDA boxed warning, FDA cautionary labeling, clinical literature or a YouScript® algorithm-predicted significant effect: Amitriptyline (Elavil), Aripiprazole (Abilify), Atomoxetine (Strattera), Carvedilol (Coreg), Celecoxib (Celebrex), Citalopram (Celexa), Clobazam (Onfi), Clomipramine (Anafranil), Clopidogrel (Plavix), Clozapine (Clozaril), Codeine [Tylenol #3 (combo)], Desipramine (Norpramin), Dextromethorphan (Delsym), Diazepam (Valium), Doxepin (Sinequan), Escitalopram (Lexapro), Esomeprazole (Nexium), Fesoterodine (Toviaz), Flecainide (Tambocor), Fluoxetine (Prozac), Flurbiprofen (Ansaid), Fluvoxamine (Luvox), Haloperidol (Haldol), Hydrocodone , Ibuprofen (Motrin), Iloperidone (Fanapt), Imipramine (Tofranil), Indomethacin (Indocin), Meloxicam (Mobic), Metoprolol (Toprol XL), Mexiletine (Mexitil), Nortriptyline (Pamelor), Omeprazole (Prilosec), Oxycodone (Oxycontin), Paroxetine (Paxil), Perphenazine (Trilafon), Phenobarbital (Luminal), Phenytoin (Dilantin), Pimozide (Orap), Piroxicam (Feldene), Proguanil [(Malarone (combo)], Propafenone (Rythmol), Propranolol (Inderal), Risperidone (Risperdal), Sertraline (Zoloft), Tetrabenazine (Xenazine), Thioridazine (Mellaril), Timolol (Apotimol), Tolterodine (Detrol), Torsemide (Demadex), Tramadol (Ultram), Trimipramine (Surmontil), Venlafaxine (Effexor), Voriconazole (Vfend), Vortioxetine (Brintellix), Warfarin (Coumadin).

Exclusion Criteria:

Previous CYP testing (CPT codes 81225, 81226, 81227, 81355, 81401)
History of organ transplant (199.2; 238.77; 414.06; 414.07; 996.80-996.89; E878.0; V42.0-V42.7; V42.81-V42.84; V42.89; V42.9; V45.87; V49.83; V58.44)
Current malabsorption syndrome (579.0), including the following: Intestinal malabsorption (579.8, 579.9), Postoperative malabsorption (579.3), or Short bowel syndrome (579.3)
Treatment of invasive solid tumors or hematologic malignancies in the last year, excluding in situ cancers or non-melanoma skin cancer (basal cell carcinoma)
End Stage Renal Disease (ESRD)
Persistent acute renal failure: complete loss of kidney function >4 weeks (requiring dialysis)
Renal failure by: Glomerular filtration rater (GFR): SCr > 3 times baseline or GFR decreased 75% or SCr ≥4 mg/dL; acute rise ≥0.5 mg/dL; OR Urine Output (UO): UO < 0.3 mL/kg/h 24 h (oliguria) or anuria 12 h.

Name	Affiliation	Role
Lindsay Elliott, PharmD	Harding University	Principal Investigator

Facility	Status	City	State	ZIP	Country	Contacts
White County Medical Center Home Health		Searcy	Arkansas	72143	United States

References Module

Citations

PubMed Identifier	Type	Citation	Retractions
28151991	Result	Elliott LS, Henderson JC, Neradilek MB, Moyer NA, Ashcraft KC, Thirumaran RK. Clinical impact of pharmacogenetic profiling with a clinical decision support tool in polypharmacy home health patients: A prospective pilot randomized controlled trial. PLoS One. 2017 Feb 2;12(2):e0170905. doi: 10.1371/journal.pone.0170905. eCollection 2017.

Label	URL
Clinical impact of pharmacogenetic profiling with a clinical decision support tool in polypharmacy home health patients: A prospective pilot randomized controlled trial	View source

ID	Title	Description
FG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
FG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

ID	Title	Description
BG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
BG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System
BG002	Total	Total of all reporting groups

Units	Counts
Participants	BG00053 BG00157 BG002110

Categories

Title	Measurements
<=18 years	BG0000 BG0010 BG0020
Between 18 and 65 years

Age, Continuous

Baseline data was extracted from patient charts & manually entered into the study database.Study pharmacist reviewed DDIs, DGIs, and cumulative drug and/or gene interactions in the tested group using the YouScript generated reports and CDST to provide drug therapy recommendations to clinicians, after which prescriptions were altered at clinician discretion. Patients in the untested group were screened for DDIs using standard drug information resources (Lexicomp) with recommendations acted on according to clinician judgment. Time to change therapy was similar to those in the tested group.

Mean

Standard Deviation

years

Title

Denominators

Categories

Title	Measurements
	BG00074.6± 11.9 BG001

Sex: Female, Male

Count of Participants

Participants

Title

Denominators

Categories

Title	Measurements
Female	BG00036 BG00132 BG002

Race (NIH/OMB)

Count of Participants

Participants

Title

Denominators

Categories

Title	Measurements
American Indian or Alaska Native	BG0000 BG0010 BG002

Region of Enrollment

Number

participants

Title

Denominators

Categories

United States

Title	Measurements
	BG00053 BG00157 BG002

OASIS Metrics

OASIS (Outcome and Assessment Information Set) Score represents an outcome measure in home health at an individual patient level to plan care, measure quality, and calculate reimbursement. On an overall scale of 0 to 3, a lower number represents a better outcome.

Average Pharmacogenetic Risk score estimates individual patient risk of having at least one significant adverse drug event due to genetic variation. Total range is 0 to 100, representing percentage, where a larger number indicates a higher risk.

Mean

Full Range

Scores on a scale

Title

Denominators

Categories

OVERALL OASIS SCORE

Title	Measurements
	BG0001.63(0 to 3) BG001

Type

Title

Description

Population Description

Reporting Status

Anticipated Posting Date

Parameter Type

Dispersion Type

Unit of Measure

Calculate Percentage

Time Frame

Units Analyzed

Denominator Units Selected

Arm/Group Information

Denominators

Classes

Analyses

Primary

Number of Re-hospitalizations at 30 and 60 Days

The primary outcomes included the number of re-hospitalizations at 30 and 60 days.

Primary outcomes included the number of re-hospitalizations between the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

Re-hospitalizations

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units	Counts
Participants	OG00053 OG00157

Title

Denominators

Categories

Re-hospitalizations at 30 Days

Title	Measurements
	OG0000.38(0 to 2) OG0010.25(0 to 3)

Re-hospitalizations at 60 Days

Title	Measurements
	OG000

Group IDs	Group Description	Statistical Method	Statistical Comment	P-Value	P-Value Comment	Parameter Type	Parameter Value	Dispersion Type	Dispersion Value	Confidence Interval Sides	Confidence Interval %	CI Lower Limit	CI Upper Limit	CI Lower Limit Comment	CI Upper Limit Comment	Estimate Comment	Tested Non-Inferiority	Non-Inferiority Type	Non-Inferiority Comment	Other Analysis Description
OG000 OG001		Regression, Poisson		0.21	P-value for 30 days measure.	Risk Ratio (RR)	0.65			2-Sided	95	0.32	1.28					Other
OG000 OG001		Regression, Poisson

Primary

The Primary Outcomes Included the Number of Emergency Department Visits at 30 and 60 Days.

Assessed the number of Emergency Department visits at 30 and 60 days post discharge with pharmacogenetic testing and YouScript® Personalized Prescribing system.

The primary outcomes assessed the number of emergency department visits between the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

ED visits

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units	Counts
Participants

Secondary

Time to 1st Re-hospitalization

To assess time to first re-hospitalization, we compared the exploratory time-to-event outcomes between the tested and untested groups at 30 days and 60 days. These outcomes were measured using cumulative percentage events at 30 and 60 days, referring to the percentage of subjects re-hospitalized before or at 30 and 60 days.

We compared the exploratory time-to-event outcomes between the tested and untested groups at 30 days and 60 days.

Posted

Number

Percentage of participants

30 days, 60 days

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units	Counts
Participants

Secondary

Time to 1st Emergency Department Visit

To assess time to first emergency department visit, we compared the exploratory time-to-event outcomes (time to 1st ED visit) between the tested and untested groups at 30 days and 60 days. These outcomes were measured using cumulative percentage events at 30 and 60 days, referring to the percentage of subjects who visited the emergency department before or at 30 and 60 days.

Compared the exploratory time-to-event outcomes between the tested and untested groups at 30 days and 60 days.

Posted

Number

Percentage of participants

30 days, 60 days

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units	Counts

Secondary

Overall Status as Measured by Outcome and Assessment Information Set (OASIS) Scale

We assessed the impact of genetic testing on overall status according to OASIS M1034 at 30 and 60 days post discharge. OASIS measures various data items to assess home health care quality and performance. OASIS M1034, one data point in the OASIS system, measures overall patient status on a scale of 0 to 3, with a lower score indicating better overall status.

The secondary outcomes assessed the overall status according to OASIS M1034 of the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

Scores on a scale

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Secondary

Pain as Measured by OASIS Scale

We assessed the impact of genetic testing on patient pain frequency according to OASIS M1242 at 30 and 60 days post discharge. OASIS measures various data items to assess home health care quality and performance. OASIS M1242, one data point in the OASIS system, measures patient pain frequency on a scale of 0 to 4, with a lower score indicating less frequent pain.

The secondary outcomes assessed frequency of pain according to OASIS M1242 of the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

Scores on a scale

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units	Counts

Secondary

Confusion as Measured by OASIS Scale

We assessed the impact of genetic testing on frequency of confusion according to OASIS M1710 at 30 and 60 days post discharge. OASIS measures various data items to assess home health care quality and performance. OASIS M1710, one data point in the OASIS system, measures patient confusion frequency on a scale of 0 to 4, with a lower score indicating less frequent confusion.

The secondary outcomes assessed frequency of confusion according to OASIS M1710 of the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

Scores on a scale

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units

Secondary

Anxiety as Measured by OASIS Scale

We assessed the impact of genetic testing on frequency of anxiety according to OASIS M1720 at 30 and 60 days post discharge. OASIS measures various data items to assess home health care quality and performance. OASIS M1720, one data point in the OASIS system, measures patient confusion frequency on a scale of 0 to 3, with a lower score indicating less frequent confusion.

The secondary outcomes assessed frequency of anxiety according to OASIS M1720 of the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

Scores on a scale

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units

Secondary

Depression as Measured by Patient Health Questionnaire (PHQ)-2 Scale

We assessed the impact of genetic testing on frequency of depressive mood according to PHQ-2 at 30 and 60 days post discharge. PHQ-2 evaluates patient depression by assessing two factors: frequency of little interest or pleasure in doing things and frequency of feeling down, depressed, or hopeless. This outcome measure assessed the second factor, frequency of feeling down or depressed. The scale for this factor ranges from 0 to 3, with a lower score represented less frequent depressive feelings.

The secondary outcomes assessed feelings of depression according to PHQ-2 of the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

Scores on a scale

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Secondary

Disruptive Behavior as Measured by OASIS Scale

We assessed the impact of genetic testing on frequency of disruptive behavior according to OASIS M1745 at 30 and 60 days post discharge. OASIS measures various data items to assess home health care quality and performance. OASIS M1745, one data point in the OASIS system, measures frequency of disruptive behavior by patient on a scale of 0 to 5, with a lower score indicating less frequent disruptive behavior.

The secondary outcomes assessed frequency of disruptive behavior according to OASIS M1745 of the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

Scores on a scale

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Secondary

Activities of Daily Living as Measured by OASIS Scale

We assessed the impact of genetic testing on the frequency of activities of daily living (ADL) and instrumental activities of daily living (IADL) assistance according to OASIS M2110 at 30 and 60 days post discharge. OASIS measures various data items to assess home health care quality and performance. OASIS M2110, one data point in the OASIS system, measures frequency of receiving ADL/IADL assistance on a scale of 0 to 5, with a lower score indicating less frequent assistance.

The secondary outcomes assessed frequency of ADL and IADL according to OASIS M2110 of the tested group and the untested group at 30 and 60 days post-discharge.

Posted

Mean

Full Range

Scores on a scale

30 days, 60 days post discharge

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Secondary

Number of Falls as Measured by Tabulation

To assess whether YouScript® testing decreases falls

Posted

Mean

Full Range

Falls

60 days

ID	Title	Description
OG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)
OG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units	Counts
Participants	OG000

Secondary

Number of Pharmacist-accepted of Recommendations as Measured by Tabulation

To assess the proportion of YouScript® Personalized Prescribing System recommendations accepted by the study pharmacist and passed on to clinicians.

This secondary outcome assessed the proportion of YouScript® Personalized Prescribing System recommendations provided for patients in the "tested" group accepted by the study pharmacist and passed to clinicians.

Posted

Number

recommendations

60 days

ID	Title	Description
OG000	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units	Counts
Participants	OG000

Secondary

Number of Clinician-accepted of Recommendations as Measured by Tabulation

To assess the proportion of study pharmacist recommendations acted on by clinicians.

This secondary outcome assessed the proportion of YouScript® Personalized Prescribing System recommendations provided for patients in the "tested" group acted on by clinicians.

Posted

Number

recommendations

60 days

ID	Title	Description
OG000	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System

Units	Counts
Participants	OG000

Arm/Groups

ID	Title	Description	Deaths (Affected)	Deaths (At Risk)	Serious Events (Affected)	Serious Events (At Risk)	Other Events (Affected)	Other Events (At Risk)
EG000	Controls ("Not Tested")	Treatment as usual (e.g. review of potential drug-drug interactions via Lexicomp Online)	6	53	0	0	0	0
EG001	Intervention ("Tested")	Patients in the "tested" group will receive pharmacogenetic testing via YouScript® Personalized Prescribing System. The study pharmacist will review drug-drug, drug-gene, and drug-drug-gene interactions using YouScript® to provide drug therapy recommendations to prescribers. Pharmacogenetic testing: Pharmacogenetic testing via YouScript® Personalized Prescribing System	1	57	0	0	0	0

ID	Term
D064420	Drug-Related Side Effects and Adverse Reactions
C563835	Drug Metabolism, Poor, CYP2D6-Related
C563703	Drug Metabolism, Poor, CYP2C19-Related

ID	Term
D005820	Genetic Testing
D019411	Clinical Laboratory Techniques
D019937	Diagnostic Techniques and Procedures
D003933	Diagnosis
D008919	Investigative Techniques
D005821	Genetic Techniques
D033142	Genetic Services
D006296	Health Services
D005159	Health Care Facilities Workforce and Services
D003954	Diagnostic Services
D011314	Preventive Health Services