Drug therapy problems
Drug Therapy Problems is a categorization of drug problems in the field of Pharmaceutical care that happen between physician, pharmacist 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>
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.
A further breakdown of the DRP categories (Ref 10):
Indication
Requires Additional Drug Therapy
Untreated condition
Preventative / prophylactic
Synergistic / potentiating
Unnecessary Drug Therapy
No medical indication
Duplicate therapy
Non-drug therapy indicated
Treating avoidable ADR
Effectiveness
Requires Different Drug Product
More effective drug available Condition refractory to drug Dosage form inappropriate Not effective for condition
Dosage Too Low
Wrong dose Frequency inappropriate Duration inappropriate Drug interaction
Safety
Adverse Drug Reaction
Undesirable effect Unsafe drug for patient Dose changed too quickly Allergic reaction Contraindications present
Dosage Too High
Wrong dose Frequency inappropriate Incorrect administration Drug interaction
Adherence
Non-adherence
Directions not understood
Patient prefers not to take
Patient forgets to take
Drug product too expensive
Cannot swallow/administer
Drug product not available
References
- ↑ Chaves-Carballo, Enrique, PEDIATRIC NEUROLOGY, V. 13 (2),03/1995
- ↑ Schacter, Daniel (2012). Psychology. United States of America: Worth Publisher. p. 201. ISBN 978-1-4292-3719-2.
- ↑ 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.
- ↑ Shargel,Leon. Comprehensive Pharmacy Review 7th Edition p. 563
- ↑ Pharmaceutical Care Practice: The Clinician's Guide, 2e chapter 1
- ↑ Pharmacotherapy Casebook: A Patient-Focused Approach, 7e Chapter "Identification of Drug Therapy Problems"
- ↑ http://www.theannals.com/cgi/content/abstract/30/2/119
- ↑ "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.
- ↑ http://www.ashp.org/s_ashp/docs/files/advocacy/policy_alert/MN_MTM_1_14_08.pdf
- ↑ http://eprints.usm.my/9696/1/DRUG_THERAPY_PROBLEMS_AND_QUALITY_OF_LIFE_IN_PATIENTS_WITH_CHRONIC_KIDNEY_DISEASE.pdf
- ↑ 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
- ↑ Can Fam Physician. 1969 March; 15(3): 47–51.