Table 3.

Return of results, prescriber communication, and clinical action

	CYP2D6-opioids			CYP2C19-PPI		CYP2D6/CYP2C19-SSRIs
	OneFlorida Primary Care	UF Health Primary Care	UF Health & Moffitt Specialty Clinics	UF Health Specialty Clinics	Nemours Children’s Health Specialty Clinics	UF Health Specialty Clinics
Total genotyped	80	235	38	61	30	25
Test results available to prescriber	Fax	EHR		EHR	Email	EHR
Actionable phenotypes	UM, range (i.e., NM-UM, IM-NM),a IM, PM			UM, RM, IM, PM		UM, PM for CYP2D6 and/or UM, RM, PM for CYP2C19
General drug therapy recommendations	Switch to non-CYP2D6 mediated opioid (e.g., morphine) or nonopioid analgesic, or if reasonable (and relevant) discontinue CYP2D6 inhibitor			50–100% Dose increase for UM/ RM25–50% dose decrease for IM/PM	100% dose increase for UM, 50% dose increase for RM, 50% dose decrease for IM/PM	Avoid SSRI that is metabolized by the CYP enzyme that is actionable; use fluoxetine if actionable phenotype in both CYP2D6/ CYP2C19
Method for recommendation communication to prescriber	General information sheet	Patientspecific consults provided	Patient-specific consults provided and information sheet	Consults upon requestc and general information sheet	Research coordinator communicated protocol recommendation	Patient-specific consults provided
Participants with an actionable phenotype,b n (%)	19 (24)	104 (44)	12 (32)	33 (54)	15 (50)	12 (48)d
Participants with an actionable phenotype who had a medication change that aligned with phenotype, n (%)	1 (5)	23 (22)	2 (17)	9 (27)	13 (87)	11 (100)e
When genotype results are used typically (for the majority)				Next visit	fOnce resulted	Appointment at week 2 of studyf

EHR electronic health record, IM intermediate metabolizer, NM normal metabolizer, PM poor metabolizer, PPI proton pump inhibitor, RM rapid metabolizer, SSRI selective serotonin reuptake inhibitor, UF University of Florida, UM ultrarapid metabolizer.

^aWhen copy-number variation was present, it sometimes resulted as a range phenotype because the copy-number variation could not be detected for specific alleles.

^bPhenotype accounts for phenoconversion.

^cZero consults requested.

^dParticipants only counted once, participants with at least one gene with a phenotype warranting a recommendation.

^e11 of 11, as one individual had a phenotype that was considered actionable, but did not start an SSRI. Three individuals continued their SSRI that was metabolized by an actionable CYP enzyme, but had dose increases and thus counted as aligning with phenotype.

^fAppointments were scheduled at week two of the study to allow for genotype results to be acted upon.