Drug therapy problems

Drug therapy problems is a categorization of drug problems in the field of pharmaceutical care that happen between physicians, pharmacists and patients.[1] However it can also be used as a definition of the specific manners in which drug therapy can cause problems. These problems are then identified, prevented, and resolved primarily by pharmacists, but it can be taken care of by any health-care provider that provides pharmaceutical care.[2] A common problem physicians face is the risk of patients building a tolerance to the drugs taken (such as morphine to control pain) which leads to the patient's body requiring higher doses for the drug to be effective, which can lead to drug overdoses. Additionally, many side-effects of drugs inhibit the body from absorbing necessary nutrients.[3]

A drug-therapy (related) problem (DTP) can be defined as an event or circumstance involving drug treatment that actually or potentially interferes with the patient experiencing an optimum outcome of medical care. In 1990, L.M. Strand and her colleagues classified the DTPs into different categories. According to these categories, pharmacists generated a list of the DTPs for each patient. As a result, pharmacists had a cleaner picture of the patient's drug therapy and medical conditions. Providing more information to pharmacists for following up patient's drug therapy caused a change in name of the term "DTP" to "DTPsm", "drug therapy problem for seamless monitoring".<ref name:"Nickerson">Nickerson, Ann; Neil J. MacKinnon, Nancy Roberts and Lauza Saulnier (October 2005), Drug-Therapy Problems, Inconsistencies and Omissions Identified During a Medication Reconciliation and Seamless Care Service, Health Care Quarterly Vol.  Cite uses deprecated parameter |coauthors= (help); </ref>

The eight problems

According to page 73 in Introduction to Health Care Delivery: A Primer for Pharmacists, Drug Therapy Problems (DTP) originated from Strand et al. (1990) who defined eight problems that could result in poorer health outcomes in an attempt to categorize DTP. (http://www.theannals.com/cgi/content/abstract/24/11/1093). Helper and Strand later in 1990 stated the mission statement or raison d'etre of pharmacists should be to correct these drug therapy problems.

The original eight problems have now been condensed into seven categories of problems. As given by Shargel, they are:

  1. Unnecessary drug therapy. This could occur when the patient has been placed on too many medications for their condition and the drug is simply not needed.
  2. Wrong drug. This could occur when a patient is given medication that does not treat the patient's condition. Ex. A heart medication to treat an infection.
  3. Dose too low. This could occur when a patient is given medication that is not strong enough to get beneficial or therapeutic effects.
  4. Dose too high. This could occur when a patient is given medication that is too strong and is causing detrimental effects or is simply not necessary.
  5. Adverse drug reaction. This could occur when a patient has an allergic response to a medication.
  6. Inappropriate adherence. This could occur when a patient chooses not to or forgets to take a medication.
  7. Needs additional drug therapy. This could occur when a patient needs more medication to treat their condition.

Further breakdown of DRP categories

A further breakdown of the DRP categories (Ref 10):[4][5][6][7][8][9] [10][11][12]

Indication

Requires Additional Drug Therapy

Unnecessary Drug Therapy

Effectiveness

Requires Different Drug Product

Dosage Too Low

Safety

Adverse Drug Reaction

Dosage Too High

Adherence

Non-adherence

See also

References

  1. ↑ Chaves-Carballo, Enrique, PEDIATRIC NEUROLOGY, V. 13 (2),03/1995
  2. ↑ Schacter, Daniel (2012). Psychology. United States of America: Worth Publisher. p. 201. ISBN 978-1-4292-3719-2.
  3. ↑ White, R.; Ashworth, A. (2000). "How drug therapy can affect, threaten and compromise nutritional status". Journal of Human Nutrition and Dietetics 13 (2): 119–129.
  4. ↑ Shargel,Leon. Comprehensive Pharmacy Review 7th Edition p. 563
  5. ↑ Pharmaceutical Care Practice: The Clinician's Guide, 2e chapter 1
  6. ↑ Pharmacotherapy Casebook: A Patient-Focused Approach, 7e Chapter "Identification of Drug Therapy Problems"
  7. ↑ http://www.theannals.com/cgi/content/abstract/30/2/119
  8. ↑ "Drug therapy management: an empirical report of drug therapy problems, pharmacists' interventions, and results of pharmacists' actions". J Am Pharm Assoc (2003) 43 (4): 511–8. 2003. PMID 12952316.
  9. ↑ http://www.ashp.org/s_ashp/docs/files/advocacy/policy_alert/MN_MTM_1_14_08.pdf
  10. ↑ http://eprints.usm.my/9696/1/DRUG_THERAPY_PROBLEMS_AND_QUALITY_OF_LIFE_IN_PATIENTS_WITH_CHRONIC_KIDNEY_DISEASE.pdf
  11. ↑ Adapted from: Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: The Clinician’s Guide, 2nd edition. New York: McGraw-Hill, 2004 Adapted by: Carla Dillon, Kimberly Duggan
  12. ↑ Can Fam Physician. 1969 March; 15(3): 47–51.
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