Development of consensus criteria for problematic medications in active duty service members

Medications play an essential role maintaining the health and readiness of active duty service members (ADSMs). Despite the importance of aligning medication use with operational requirements, there is no standardized, replicable framework for identifying Problematic Medications in Active Duty Service members (ProMADS).

This study aimed to develop a consensus-based list of ProMADS criteria to inform medical readiness efforts across the Military Health System.

A modified, two-round Delphi process was used to achieve expert consensus on explicit ProMADS criteria. Thirteen multidisciplinary panelists, selected for their clinical and operational expertise, independently reviewed and rated an existing set of ProMADS recommendations and rationales. Agreement was defined a priori as ≥75% of panelists endorsing both the recommendation and rationale. Panelists were invited to propose new criteria for consideration in Round 2. Responses were analyzed quantitatively for consensus and qualitatively for iterative refinement.

In Round 1, 10 of 17 (58.8%) criteria reached consensus. In Round 2, panelists reached consensus on all 17 previously introduced criteria and 4 of 7 (57.1%) new criteria suggested by participants, resulting in a final list of 21 consensus-based ProMADS criteria. Medications achieving consensus were generally categorized into five operationally relevant groups: Controlled Substances, Injectables, Refrigerated/Storage-Dependent Medications, Immunomodulators, and Blood Modifiers. Statements focused on operational feasibility such as avoidance of medications requiring frequent monitoring, refrigeration, or that might interfere with the treatment of a trauma injury.

This study generated 21 consensus-driven ProMADS criteria, offering a replicable framework for identifying medications that may compromise deployment readiness. These findings can be integrated into clinical decision support, deployment screening, and policy development within the Military Health System.