Background: Medications are necessary to optimize the health and readiness of military personnel. However, their use also has the potential to produce effects that may interfere with an active duty service member’s (ADSMs) ability to perform their military duties. The Aims of this dissertation were to: (1A) Use a replicable process to develop a comprehensive problematic medications in active-duty service members (ProMADS) list in consultation with key informants, (1B) Perform an environmental scan of ProMADS, (2) Evaluate the use of medications on a draft list of ProMADS among ADSMs, (3) Create a final ProMADS list with explicit criteria through a consensus-based process.

Methods: The framework was developed in 3 phases: (1) Semi-structured interviews with key informants, (2) Review of the literature, and (3) Feedback from an advisory committee gathered using a modified Delphi Process. A retrospective cohort study using the MHS Information Platform was conducted to describe the prevalence of medications included on a draft list of ProMADS. This quantitative information, along with the qualitative information from semi-structured interviews and an environmental scan, was used by panel members to generate a consensus list of explicit ProMADS criteria using a modified Delphi process.

Results: The resulting framework consists of five key concepts associated with medications that may impact operational readiness. An environmental scan yielded 32 articles related to ADSMs, medications, and deployment. Quantitative analysis of a draft ProMADS medication list estimated that approximately 24% of ADSMs received at least one prescription for a medication on the ProMADS list within a three-year period. These concepts, linked to literature and data, informed Delphi panel members who achieved consensus on 21 explicit criteria for ProMADS.

Conclusions: The developed framework provides a replicable process to support the ongoing generation of explicit criteria for ProMADS. An analysis of pharmacy claims showed that an operationally relevant number of ADSMs receive ProMADS, in many cases from different prescribers, dispensed from a combination of military, mail-order, and retail pharmacies. Explicit consensus-based criteria promote standardization, foster discussion, and can be used to inform future military health system research and medical readiness programs.