Drug therapy problems (DTP) is a categorization of drug problems in the field of pharmaceutical care that happen between physicians, pharmacists and patients. 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. 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.
Contents
- The original eight problems
- Further breakdown of categories
- Indication
- Effectiveness
- Safety
- Adherence
- References
A drug-therapy (related) problem 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 (based on previous works 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. 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". 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
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 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.
- 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
A further breakdown of the DRP categories (Ref 10):
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