A Review on Drug Therapy Problems

 

Shraddha. B. Patil*, Bhavana. U. Jain, Manish Kondawar

Department of Pharmaceutical Chemistry, Appasaheb Birnale College of Pharmacy, Sangli-416416

District: Sangli, India

 

ABSTRACT:

Drug therapy problems are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying drug therapy problem help patients to achieve their goals of therapy and understand the best possible outcome from drug therapy. Drug therapy problem represent the foremost responsibility of pharmaceutical care practitioner. Medication Therapy Management is medical care provided by the pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. It is medical care provided by the pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. Medication Therapy Management includes five core components: A medication therapy review [MTR], Personal medication record [PMR], Medication rela Documentation Ted action plan [MAP] Intervention and or referral, and Documentation and follow up. These proposed methods were successfully applied for simultaneous maintenance of the patient pharmacist relationship^[1]

 

 

 

1. INTRODUCTION:

A drug therapy problem is any undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy and requires professional judgment to resolve. It can be an event or circumstances involving drug treatment i.e. pharmacotherapy that interferes with optimal provision of medical care. A correctly stated drug therapy problem includes (a) a description of the patient's condition or problem, (b) the drug therapy involved, and (c) the specific association between the drug therapy and the patient's condition.^[2-4]

 

In 1990, L.M. Strand and her colleagues classified the Drug Therapy Problems into different categories. According to these categories, pharmacists generated a list of the Drug Therapy Problems 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" The original eight problems have now been condensed into seven categories of problem.

 

1.1 CATEGORIES:

1.     Unnecessary drug therapy. This could occur when the patient has been placed on to 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. For e.g. 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 effect.

 

4.       Dose too high. This could occur when a patient is given medication is too strong and it 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 choose not to or forget to take a medication.

 

7.       Needs additional drug therapy. This could occur when a patient needs more medication to treat their condition.

 

1.2 CAUSES OF DRUG THERAPY PEOBLEMS:

·       Drug/Dose selection

·       Drug use process

·       Information

·       Patient/physiological

·       Logistics

 

2. MEDICATION THERPAY MANAGEMENT [MTM]:

Medication Therapy Management is a distinct service or group of services that optimize therapeutic Outcomes for individual patients. Medication Therapy Management Services are independent of, but can occur in conjunction with, the provision of a medication product. ^[5-8]

 

 

Figure 1: Flow Chart of Medication Therapy Management Service Model.

 

2.1 MEDICATION THERPY REVIEW [MTR]:

The medication therapy review (MTR) includes a systematic process of 1) collecting patient-specific information,2) assessing medication therapies to identify medication-related problems, 3) developing a prioritized list of medication-related problems, and 4) creating a plan to resolve them. A MTR is conducted between the patient and the pharmacist. Pharmacist-provided MTR and consultation in various settings has resulted in reductions in physician visits, emergency department visits, hospital days, and overall healthcare costs. In addition, pharmacists have been shown to obtain accurate and efficient medication related information from patients.

 

 

2.2 PERSONAL MEDICATION RECORD [PMR]:

The personal medication record (PMR) is a comprehensive record of the patient’s medications (prescription and nonprescription medications, herbal products, and other dietary supplements). The PMR, which is intended for use by the patient, may include the following information:

·       Patient name

·       Patient birth date

·       Patient telephone number

·       Emergency contact information (name, telephone number, and relationship)

·       Primary care physician (name and telephone number)

·       Pharmacy/pharmacist (name and telephone number)

·       Allergies (e.g., what allergies do I have? What happened when I had the allergy or reaction?)

·       Other medication-related problems (e.g., what medication caused the problem? What was the problem I had?)

·       Potential questions for patients to ask about their medications

      (e.g., when you are prescribed a new drug, ask your doctor or Pharmacist...)

·       Date last updated

·       Date last reviewed by the pharmacist, physician, or other health care professional

·       Patient’s signature

·       Health care provider’s signature

·       For each medication, inclusion of the following:

Ø Medication (e.g., drug name and dose)

Ø Indication (e.g., Take for…)

Ø Instructions for use (e.g., When do I take it?)

Ø Start date

Ø Stop date

Ø Ordering prescriber/contact information (e.g., doctor)

Ø Special instructions

 

The medication-related action plan (MAP) is a patient-centric document containing a list of actions for the patient to use in tracking progress for self-management. The MAP, which is intended for use by the patient, may include the following information:

·       Patient name

·       Primary care physician

·       (Doctor’s name and phone number)

·       Pharmacy/pharmacist

·       (Pharmacy name/pharmacist name and phone number)

·       Date of MAP creation (Date prepared)

·       Action steps for the patient: “What I need to do...”

·       Notes for the patient: “What I did and when I did it...”

·       Appointment information for follow-up with pharmacist, if applicable Specific items that require intervention and that have been approved by other members of the healthcare team and any new items within the pharmacist’s scope of practice should be included on a MAP distributed to the patient on a follow-up visit.

 

2.3 MEDIATION RELATED ACTION PLAN [MAP]:

The medication-related action plan (MAP) is a patient-centric document containing a list of actions for the patient to use in tracking progress for self-management. The MAP, which is intended for use by the patient, may include the following information:

·       Patient name

·       Primary care physician

·       (Doctor’s name and phone number)

·       Pharmacy/pharmacist

·       (Pharmacy name/pharmacist name and phone number)

·       Date of MAP creation (Date prepared)

·       Action steps for the patient: “What I need to do...”

·       Notes for the patient: “What I did and when I did it...”

·       Appointment information for follow-up with pharmacist, if applicable Specific items that require intervention and that have been approved by other members of the healthcare team and any new items within the pharmacist’s scope of practice should be included on a MAP distributed to the patient on a follow-up visit. In institutional settings the MAP could be

 

Established at the time the patient is discharged for use by the patient in medication self-management.

 

2.4 INTERVENTION AND OR REFERRAL:

The pharmacist provides consultative services and intervenes to address medication-related problems; when necessary, the pharmacist refers the patient to a physician or other healthcare professional. During the course of a Medication Therapy Management encounter, medication-related problems may be identified that require the pharmacist to intervene on the patient’s behalf. Interventions may include collaborating with physicians or other healthcare professionals to resolve existing or potential medication-related problems or working with the patient directly. The communication of appropriate information to the physician or other healthcare professional, including consultation on the selection of medications, suggestions to address medication problems, and recommended follow-up care, is integral to the intervention component of the Medication Therapy Management service model. Consultative services and pharmacist interventions to address medication-related problems. When necessary, the pharmacist refers the patient to a physician or other health care professional

 

Follow-up:

When a patient’s care setting changes (e.g., hospital admission, hospital to home, hospital to long-term care facility, home to long-term care facility), the pharmacist transitions the patient to another pharmacist in the patient’s new care setting to facilitate continued Medication Therapy Management services. In these situations, the initial pharmacist providing Medication Therapy Management services participates cooperatively with the patient’s new pharmacist provider to facilitate the coordinated transition of the patient, including the transfer of relevant medication and other health-related information. If the patient will be remaining in the same care setting, the pharmacist should arrange for consistent follow-up Medication Therapy Management services in accordance with the patient’s unique medication related needs. All follow-up evaluations and interactions with the patient and his or her other health care professional (s) should be included in Medication Therapy Management documentation.

 

2.5 Documentation:

Documentation is an essential element of the Medication Therapy Management service model. The pharmacist documents services and intervention(s) performed in a manner appropriate for evaluating patient progress and sufficient for billing purposes.

 

Ideally, documentation will be completed electronically or alternatively on paper. The inclusion of resources such as a personal medication record, a medication-related action plan, and other practice-specific forms will assist the pharmacist in maintaining consistent professional documentation. The use of consistent documentation will help facilitate collaboration among members of the healthcare team while accommodating practitioner, facility, organizational, or regional variations.

 

Table No.1: Documentation Category with Example

Documentation category	Examples
Patient demographics	Basic information: address, phone, e-mail, gender, age ,  ethnicity, education status, patient's special needs, health plan benefit/insurance coverage
Subjective observations	Pertinent patient-reported information: previous medical history, family history, social history, chief complaints, allergies, previous adverse drug reactions
Objective observations	Known allergies, diseases, conditions, laboratory results, vital signs, diagnostic signs, physical exam results, review of systems
Assessment	Problem list, assessment of medication-related problems
Plan	A care plan is the healthcare professional's course of action for helping a patient achieve specific health goals
Education	Goal setting and instruction provided to the patient with verification of understanding
Collaboration	Communication with other healthcare professionals: recommendations, referrals, and correspondence with other professionals. (cover letter, SOAP note)
PMR	A record of all medications, including prescription and nonprescription medications, herbal products, and other dietary supplements
MAP	Patient-centric document containing a list of actions to use in tracking progress for self-management
Follow-up	Transition plan or scheduling of next follow-up visit
Billing	Amount of time spent on patient care, level of complexity, amount charged

 

 

CONCLUSION:

The knowledge provided by this review article report for by use of pharmacist involved in providing Medication Therapy Management services in diverse patient care settings consist of five core elements. The Pharmacists Management of Drug Related Problems [PMDRP] enhances efficient delivery of service and improves patient outcomes. Every patient should obtain the appropriate drug therapy; if it cause any adverse drug reaction then pharmacist management is helpful to obtain the achieved drug therapy.

 

Studies have shown that clinical pharmacist effectively can identify, solve, and prevent clinically significant drug related problems.

 

These suggestions are helpful to most people, who are having drug therapy problems and to the pharmacist also.

 

The Medication Therapy Management core elements, as presented in this document, are intended to be applicable to patients in all care settings where the patients or their caregivers can be actively involved with managing their medication therapy, taking full advantage of the pharmacist’s role as the “medication therapy expert.” A flow chart of the core elements of a Medication Therapy Management service model contained in this document. As the core elements service model continues to evolve to meet diverse patient needs, pharmacists are encouraged to make the most of the framework provided to improve patient outcomes and medication use

 

REFERNCES:

1.      Cipolle RJ, Strand LM, Mortey PC, Drug therapy problems

2.      Classification for drug related problems 2006;

3.      Drugtherapyproblemaccesspharmacy.mhmedical.com/content.aspx?bookid=491&sectionid=39674905

4.      Advsumilli PK, Adpu R. Drug related problems; an overview of various classification system2014; 7(4); 7-10.

5.      Medication therapy management service definition and program criteria

6.      Medication therapy management in pharmacy practice: Core elements of a Medication Therapy Management service model.

7.      American pharmacists association and the national association of chain drug stores foundation-Medication therapy management in pharmacy practice: Core elements of Medication Therapy Management service model (Version 2.0)2008; 98; 341-35.

8.      Davanzo.J, Dobson.A, Koenig L, Robert book. Medication therapy management services: A critical review. https://www.pharmacist.com/sites/default/files/.../mtm_promo_flyr_health_plans.pdf

 

 

 

 

Accepted on 02.04.2019            © A&V Publications All right reserved