Pharmacy Practice: Drug Therapy Problems

Drug Therapy Problems

• Definition: Undesirable event experienced by a patient, involving or suspected to involve drug therapy, and interfering with achieving desired therapy goals.
• Components of a Drug Therapy Problem:
  • Undesirable event or risk of an event experienced by the patient
  • The drug therapy (products and/or dosage regimen) associated with the problem
  • The relationship between the undesirable patient event and drug therapy

Categories and Common Causes of Drug-Related Problems

• Non-Compliance:
  • Patient's inability or unwillingness to take a drug regimen
  • The number of doses not taken or taken incorrectly
  • Common causes: patient does not understand instructions, patient prefers not to take medications, patient forgets to take medications, high cost of medication, etc.
• Medications most frequently involved in non-adherence problems: Metformin HCL, Rosuvastatin Calcium (Crestor), Insulin, Albuterol inhalers
• Medications patient often cannot afford: Table 5-20 (pg 174)

Pharmaceutical Care Practice

• Factors that motivate an appropriately qualified individual to prescribe:
  • Rational approach: use evidence, evaluate alternative medications, match the best available medication
  • Emotional element: responsive to appeals from patients, pharmaceutical industry, professional colleagues, and own instincts
• Rational and effective prescribing:
  • Saves lives and improves quality of life
  • Requires the patient to receive medication appropriate to their clinical needs, in the right dose, at the right time, and for the right duration
  • 5-rights: “The right drug, in the right place, at the right time, at the right dose for the right duration”
• Good prescribing has four components:
  • Maximize effectiveness
  • Minimize risk
  • Minimize cost
  • Respect patient choices

Inappropriate Prescribing

• Characterized by:
  • Prescribing medicines for self-limiting diseases
  • Prescribing medicines of limited clinical value
  • Prescribing too low a dose of a medicine
  • Continuing to prescribe a medicine for too long
  • Not prescribing a medicine for an appropriate duration
  • Prescribing a medicine that is inappropriate for the disorder to be treated
• Consequences of inappropriate prescribing:
  • Distress
  • Ill health
  • Hospitalization
  • Death
  • Waste of resources (e.g., antimicrobial prescribing and risk of bacterial resistance)

A Systematic Approach to Prescribing

• Consultation skills and competencies:
  • Interpersonal skills: ability to communicate and make relationships with patients
  • Reasoning skills: ability to gather and interpret information and apply it in diagnosis and management
  • Practical skills: ability to perform physical examinations and use clinical instruments
• Consultation styles:
  • Task-oriented consultation: identification and management of presenting problems, management of continuing problems, opportunistic anticipatory care, modification of the patient's help-seeking behavior
• Typical stages of consultation:
  • Gathering relevant information
  • Medication history
  • Medical history
  • OLDCARTS: Onset, Location, Duration, Characteristics, Associated signs and symptoms, Relieving or aggravating factors, Treatment, Summarize

Prioritizing Drug Therapy Problems

• Prioritizing drug therapy problems involves resolving or preventing problems that need immediate attention, and identifying which ones can wait or require interventions by others.

Characteristics of Patients with No Drug Therapy Problems

• It is challenging to achieve a state where a patient has no drug therapy problems.
• The patient must understand how to correctly use all medications, have all their drug needs met, and not require medications to have no drug therapy problems.

Identifying, Resolving, and Preventing Drug Therapy Problems

• Pharmaceutical care practitioners uniquely contribute to patient care by identifying, resolving, and preventing drug therapy problems.
• Identifying a drug therapy problem requires associating a patient's medical condition with their pharmacotherapy.

Categories of Drug Therapy Problems

• There are seven distinct categories of drug therapy problems.
• These categories include:
• Unnecessary drug therapy
• Needs additional drug therapy
• Ineffective drug
• Dosage too low
• Adverse drug reaction
• Dosage too high
• Adherence

Stating Drug Therapy Problems

• A correctly stated drug therapy problem includes:
• A description of the patient's condition or problem
• The drug therapy involved
• The specific association between the drug therapy and the patient's condition
• A well-stated problem simplifies the solution.

Components of a Drug Therapy Problem

• A drug therapy problem involves the patient, their medical condition, and the drug therapy that connects them.
• Knowing the seven categories of drug therapy problems is a powerful concept for students and practitioners.

Prioritizing Drug Therapy Problems

• Prioritizing drug therapy problems involves resolving or preventing problems that need immediate attention, and identifying which ones can wait or require interventions by others.

Characteristics of Patients with No Drug Therapy Problems

• It is challenging to achieve a state where a patient has no drug therapy problems.
• The patient must understand how to correctly use all medications, have all their drug needs met, and not require medications to have no drug therapy problems.

Identifying, Resolving, and Preventing Drug Therapy Problems

• Pharmaceutical care practitioners uniquely contribute to patient care by identifying, resolving, and preventing drug therapy problems.
• Identifying a drug therapy problem requires associating a patient's medical condition with their pharmacotherapy.

Categories of Drug Therapy Problems

• There are seven distinct categories of drug therapy problems.
• These categories include:
• Unnecessary drug therapy
• Needs additional drug therapy
• Ineffective drug
• Dosage too low
• Adverse drug reaction
• Dosage too high
• Adherence

Stating Drug Therapy Problems

• A correctly stated drug therapy problem includes:
• A description of the patient's condition or problem
• The drug therapy involved
• The specific association between the drug therapy and the patient's condition
• A well-stated problem simplifies the solution.

Components of a Drug Therapy Problem

• A drug therapy problem involves the patient, their medical condition, and the drug therapy that connects them.
• Knowing the seven categories of drug therapy problems is a powerful concept for students and practitioners.

Identify and understand drug therapy problems, involving undesirable events experienced by patients, and their relation to achieving desired therapy goals. Learn about pharmaceutical care practice with Dr. Rami S. Mosleh.