Drug therapy problems (DTPs) (or drug related problems, DRPs) represent the categorization and definition of clinical problems related to the use of
medications or "drugs" in the field of
pharmaceutical care.[1] In the course of clinical practice, DTPs are often identified, prevented, and/or resolved by
pharmacists in the course of
medication therapy management, as experts on the safety and efficacy of medications, but other
healthcare professionals may also manage DTPs.[2]
A drug-therapy (related) problem can be defined as an event or circumstance involving
drugtreatment (
pharmacotherapy) that interferes with the optimal provision of medical care. In 1990, L.M. Strand and her colleagues (based on the previous work of R.L Mikeal[3] and D.C Brodie,[4] published respectively in 1975 and 1980) classified the DTPs into eight 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. A second publication of R.J Cipolle with L.M Strand in 1998, change the eight categories into seven, grouped in four Pharmacotherapy needs: indication, effectiveness, safety and adherence.[5]
Examples
Patients who have chronic pain that are prescribed
opioid painkillers (such as
morphine) may build up a
tolerance to the effect of the painkillers, requiring higher doses to achieve the same pain reducing effect. This risky practice of dose escalation can lead to drug overdoses.
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.[7] 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:
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.[7]
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.[7]
Dose too low. This could occur when a patient is given medication that is not strong enough to get beneficial or therapeutic effects.[7]
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.[7]
Adverse drug reaction. This could occur when a patient has an allergic response to a medication.[7]
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.[7]
^Chaves-Carballo, Enrique (1995). "Problems in pediatric drug therapy: By Louis A. Pagliaro and Ann M. Pagliaro". Pediatric Neurology (Book review). 13 (2): 181.
doi:
10.1016/0887-8994(95)90028-4.
^Mikeal, R. L.; Brown, T. R.; Lazarus, H. L.; Vinson, M. C. (1975-06-01). "Quality of pharmaceutical care in hospitals". American Journal of Hospital Pharmacy. 32 (6): 567–574.
ISSN0002-9289.
PMID1155467.
^Brodie, D. C.; Parish, P. A.; Poston, J. W. (1980-08-01). "Societal needs for drugs and drug-related services". American Journal of Pharmaceutical Education. 44 (3): 276–278.
ISSN0002-9459.
PMID10317016.
^Cipolle, Robert (1998). Pharmaceutical Care Practice. Mc Graw Hill.
ISBN978-0-07-175638-9.
^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.
doi:
10.1046/j.1365-277x.2000.00221.x.
^Shargel, Leon. Comprehensive Pharmacy Review (7th ed.). 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"
^Smith, Cynthia P.; Christensen, Dale B. (1 February 1996). "Identification and Clarification of Drug Therapy Problems by Indian Health Service Pharmacists". Ann Pharmacother. 30 (2): 119–124.
doi:
10.1177/106002809603000201.
PMID8835041.
S2CID40109294.