Patients meeting eligibility criteria will be randomized into two groups, one receiving
pharmacogenetic testing and the other not receiving pharmacogenetic testing. In this
open-label trial, a pharmacist will make medication therapy recommendations using YouScript®
Personalized Prescribing System for patients who receive genetic testing and standard drug
information resources per usual for patients who do not undergo pharmacogenetic testing.
Both groups will be followed for 60 days. The number of re-hospitalizations and emergency
department (ED) visits will be recorded as well as time to first re-hospitalization and time
to first ED visit. Select OASIS metrics (e.g. M1034, M1242, M1710, M1720, M1745, M2110) and
PHQ-2 will be evaluated and documented at time of admission to home health, at 30 days, and
at 60 days for improvement in overall status, pain, confusion, anxiety, depression,
disruptive behavior, and the need for assistance with activities of daily living (ADLs) and
instrumental activities of daily living (IADLs). The number of falls will be collected as
well as the proportion of YouScript® recommendations accepted by study pharmacist and passed
on to clinicians and the proportion of recommendations accepted by clinicians.
- 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).
- 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
- 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
- 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.