Drug therapy problems (DTPs) (or drug related problems, DRPs) represent the categorization and definition of clinical problems related to the use of
medications
Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...
or "drugs" in the field of
pharmaceutical care Pharmaceutical care is a pharmacy practice model developed in the 1990s that describes patient-centered medication management services performed by pharmacists.
Medication Management Service
There are many definitions for "medication management ser ...
. In the course of clinical practice, DTPs are often identified, prevented, and/or resolved by
pharmacists
A pharmacist, also known as a chemist in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...
in the course of
medication therapy management Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists, medical affairs, and RWE scientists that aims to improve outcomes by helping people to better understand thei ...
, as experts on the safety and efficacy of medications, but other
healthcare professionals
A health professional, healthcare professional (HCP), or healthcare worker (sometimes abbreviated as HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physi ...
may also manage DTPs.
A drug-therapy (related) problem can be defined as an event or circumstance involving
drug
A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via insufflation (medicine), inhalation, drug i ...
treatment (
pharmacotherapy
Pharmacotherapy, also known as pharmacological therapy or drug therapy, is defined as medical treatment that utilizes one or more pharmaceutical drugs to improve ongoing symptoms (symptomatic relief), treat the underlying condition, or act as a p ...
) 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 and D.C Brodie, 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.
Examples
*Patients who have chronic pain that are prescribed
opioid
Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, ...
painkillers (such as
morphine
Morphine, formerly also called morphia, is an opiate that is found naturally in opium, a dark brown resin produced by drying the latex of opium poppies (''Papaver somniferum''). It is mainly used as an analgesic (pain medication). There are ...
) 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.
*Some drugs reduce the body's absorption of
essential nutrients
A nutrient is a substance used by an organism to survive, grow and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi and protists. Nutrients can be incorporated into cells for metabolic purposes or excret ...
from food, which could lead to
nutritional deficiencies
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a Deficiency (medicine), deficiency, excess, or imbalance of energy, protein and Vitamin deficiency, other nutrients whic ...
.
The original 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.
Helper and Strand later in 1990 stated the mission statement or raison d'etre of
pharmacist
A pharmacist, also known as a chemist in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...
s 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.
# 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.
# Dose too low. This could occur when a patient is given medication that is not strong enough to get beneficial or therapeutic effects.
# 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.
# Adverse drug reaction. This could occur when a patient has an allergic response to a medication.
# Inappropriate adherence. This could occur when a patient chooses not to or forgets to take a medication.
# Needs additional drug therapy. This could occur when a patient needs more medication to treat their condition.
Further breakdown of categories
DRPs can be broken down further into the following categories:
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
{{reflist
Therapy
Pharmacy