Drug Therapy Problem Identification and Resolution

A drug therapy problem is any undesirable event a patient experiences that involves, or is suspected to involve, drug therapy and that interferes with achieving the intended goals of treatment. Identifying, resolving, and preventing these problems is the central clinical work of pharmaceutical care.

Definition

A drug therapy problem is an undesirable event or risk experienced by a patient that involves, or is suspected to involve, drug therapy and that actually or potentially interferes with a desired patient outcome; the standard taxonomy groups problems into needing additional therapy, unnecessary therapy, ineffective drug, dosage too low, adverse drug reaction, dosage too high, and non-adherence.

Scope

This topic covers the concept of the drug therapy problem, the common categories used to classify such problems (relating to indication, effectiveness, safety, and adherence), the assessment logic used to detect them, and the general approach to resolution and prevention. It is a conceptual and methodological entry and does not provide individualised treatment instructions.

Core questions

• What makes an event a drug therapy problem rather than an isolated symptom?
• What categories are used to classify drug therapy problems?
• What assessment logic reliably surfaces these problems?
• How are identified problems prioritised and addressed within a care plan?

Key concepts

• Indication, effectiveness, safety, adherence as assessment axes
• Seven-category problem taxonomy
• Actual versus potential (preventable) problems
• Adverse drug events and preventability
• Potentially inappropriate prescribing and explicit criteria
• Prioritisation and resolution planning

Key theories

Drug therapy problem taxonomy

Cipolle, Strand, and Morley organise medication-related problems into seven categories tied to the assessment of indication, effectiveness, safety, and adherence, giving the pharmacist a consistent framework for identifying what is wrong and why.

Identification as the core of pharmaceutical care

Hepler and Strand positioned the identification, resolution, and prevention of drug therapy problems as the defining clinical responsibility that distinguishes pharmaceutical care from dispensing.

Mechanisms

Drug therapy problems are surfaced by systematically asking, for each of a patient's medications, whether there is an appropriate indication, whether the drug is the most effective available, whether it is safe, and whether the patient is able and willing to take it as intended. Failures along any of these axes map to the standard problem categories. Explicit screening criteria, such as STOPP/START for older adults, can support detection of potentially inappropriate prescribing, and many drug therapy problems correspond to adverse drug events, a proportion of which are preventable.

Clinical relevance

Recognising drug therapy problems is how pharmacist-delivered care detects medication issues that may not be apparent from a prescription alone. This entry describes the construct and the logic of identification; it is a reference framework and not a substitute for clinical judgement or individualised advice.

Epidemiology

Studies of ambulatory care document that adverse drug events are common and that a meaningful share are preventable or ameliorable, underscoring why structured problem identification matters (Gandhi et al., 2003). In older adults, explicit prescribing criteria have been associated with reductions in potentially inappropriate medication use in pooled trial evidence (Hill-Taylor et al., 2016).

History

The drug therapy problem emerged as a named clinical unit alongside the pharmaceutical care philosophy in 1990 and was codified into a categorical taxonomy in the Cipolle, Strand, and Morley practice text. Parallel work on adverse drug events and on explicit prescribing criteria gave the construct an empirical and screening-based footing, linking pharmacy practice to the wider medication-safety literature.

Debates

How should drug therapy problems be classified and counted?

Multiple classification systems exist for drug-related problems, differing in granularity and in whether they count potential as well as actual problems; the lack of a single standard complicates comparison of intervention studies.

Key figures

• Linda M. Strand
• Robert J. Cipolle
• Charles D. Hepler
• Peter C. Morley

Seminal works

• hepler-strand-1990
• cipolle-strand-morley-2012

Frequently asked questions

What counts as a drug therapy problem?

Any undesirable event involving a patient's drug therapy that interferes with reaching a treatment goal — for example a missing needed medication, an ineffective drug, a safety issue such as an adverse reaction, or non-adherence.

Why are drug therapy problems organised by indication, effectiveness, safety, and adherence?

These four questions cover the essential conditions for therapy to work, and checking each one systematically helps ensure no category of problem is overlooked.