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Atănăsoie AM, Ancuceanu RV, Krajnović D, Waszyk-Nowaczyk M, Skotnicki M, Tondowska D, Petrova G, Niculae AM, Tăerel AE. Approved and Commercialized Antidiabetic Medicines (Excluding Insulin) in Seven European Countries-A Cross-Sectional Comparison. Pharmaceuticals (Basel) 2024; 17:793. [PMID: 38931460 DOI: 10.3390/ph17060793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Diabetes mellitus is a complex, multifactorial, progressive condition with a variety of approved therapeutic options. The purpose of this study was to offer an overview of the authorized antidiabetic medicines (excluding insulin) compared with marketed products in seven European countries. Data were obtained from primary sources, including the websites of national authorities and directly from specialists in the countries of interest. The range of marketed medicines compared with the authorized group was assessed in terms of active pharmaceutical ingredients (>60% in Bulgaria, France, Serbia), brand names (>70% in Bulgaria, the Czech Republic, Romania, Serbia, Spain), pharmaceutical forms (>60% in all countries), strengths (>60% in Bulgaria, the Czech Republic, Romania, Serbia, Spain), marketing authorization holder (≥50% in all countries) and the status of medicine. Spain was found to have the highest number of products based on most of these attributes. Over 90% of authorized medicines had a pharmacy price in Serbia. Regarding the newer class of GLP-1 receptor agonists, a retail price for all approved substances was available in Bulgaria, Romania, Serbia, and Spain. Only one brand name with one concentration was found available for some agents, being susceptible to drug shortages: glibenclamide (Romania, Serbia, Spain), glipizide (the Czech Republic, Poland, Romania, Spain), glisentide (Spain), acarbose (the Czech Republic), sitagliptin (Bulgaria, Poland), vildagliptin (the Czech Republic, Poland) and saxagliptin (the Czech Republic, France, Romania, Serbia). An overview of the national and international therapeutic options may allow competent authorities and health professionals to take rapid measures in case of supply problems or health crises.
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Affiliation(s)
- Ana-Maria Atănăsoie
- Department of Management and Pharmaceutical Marketing, Faculty of Pharmacy, "Carol Davila" University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Robert Viorel Ancuceanu
- Department of Pharmaceutical Botany and Cell Biology, Faculty of Pharmacy, "Carol Davila" University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Dušanka Krajnović
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
| | - Magdalena Waszyk-Nowaczyk
- Pharmacy Practice and Pharmaceutical Care Division, Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Marcin Skotnicki
- Industrial Pharmacy Division, Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | | | - Guenka Petrova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University, 1000 Sofia, Bulgaria
| | - Andrei Marian Niculae
- Department of Cellular, Molecular and Histology Biology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Adriana-Elena Tăerel
- Department of Management and Pharmaceutical Marketing, Faculty of Pharmacy, "Carol Davila" University of Medicine and Pharmacy, 020956 Bucharest, Romania
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Vann Yaroson E, Quinn G, Breen L. Medicines Shortages Reporting Systems (MSRS): An exploratory review of access and sustainability. Res Social Adm Pharm 2024; 20:72-83. [PMID: 38458895 DOI: 10.1016/j.sapharm.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The efficacy of medicines depends on their accessibility and availability. Dedicated medicine shortage reporting systems (MSRS) have been set up in different countries, either mandatory or voluntary, following the recommendations of the World Health Organisation to ensure these. OBJECTIVES To explore how the Medicine Shortages Reporting System (MSRS) can tackle medicine shortages through improved access and sustainability. METHODS Personnel directly involved in the reporting mechanisms for medicine shortages in eight (8) countries participated in semi-structured interviews. An interview protocol based on the Dynamic Capabilities View and Organisational Information Processing Theory (OIPT) was developed. It contained questions related to participant's views on the process involved in MSRS and how it was used to tackle shortages. Data were thematically analysed. RESULTS Three core elements were identified to influence MSRS's ability to tackle shortages and ensure sustainability; (1) the ability to identify what information requirements the reporting system needs, (2) identify information processing capabilities, and (3) the ability to match requirements and information processing capabilities through a dynamic capability decision-making process. The dynamic decision-making process involves reiteratively sensing shortages by understanding and validating information received. CONCLUSION Building MSRS to tackle shortages for accessibility and sustainability is a systemic process that entails understanding the various elements and processes of MSRS. It includes defining medicine shortages, reconfiguring resources, defining accessibility and ensuring the system's sustainability. Our study provides insights into MSRS developed for mitigating medicine shortages and provides a framework for a sustainable MSRS. The findings extend the literature on medicine shortage management by identifying the various elements required to set up an MSRS. It also provides practical implications for countries that seek to establish MSRS to mitigate medicine shortages. Further studies could extend the number of participating countries to provide a clearer picture of the MSRS and how it can reduce medicine shortages.
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Affiliation(s)
- Emilia Vann Yaroson
- University of Huddersfield Business School, Charles Sykes Building, Queensgate, HD1 3DH, UK.
| | - Gemma Quinn
- University of Bradford School of Pharmacy and Medical Sciences, Richmond Building, Richmond Road, Bradford, BD7 1DP, UK.
| | - Liz Breen
- University of Bradford School of Pharmacy and Medical Sciences, Richmond Building, Richmond Road, Bradford, BD7 1DP, UK.
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Hemmeda L, Tiwari A, Kolawole BO, Ayoobkhan FS, Fatima K, Shabani MM, Kundu M, Anugu NR, Richard RM, Ibrahim D, Ahmed KAHM. The critical pharmaceutical situation in Sudan 2023: A humanitarian catastrophe of civil war. Int J Equity Health 2024; 23:54. [PMID: 38481331 PMCID: PMC10938693 DOI: 10.1186/s12939-024-02103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/11/2024] [Indexed: 03/17/2024] Open
Abstract
The situation in Sudan have deteriorated since the ongoing war outbreak in April 2023. This article sheds light on the pharmacological status in Sudan in terms of shortage of supply, rising demands, and regulatory issues. The ongoing civil war has acutely impacted the dilapidated pharmaceutical status of Sudan, patients have suffered from the paucity of medical services forcing an out-of-control rise in underreported morbidity and mortality. To mitigate this uprising issue, an increase in stakeholder communication is crucial to deal with this national threat and establish a system for reporting the shortage.
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Affiliation(s)
- Lina Hemmeda
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
| | - Angad Tiwari
- Maharani Laxmi Bai Medical College, Jhansi, India
| | | | | | | | | | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | | | | | - Danya Ibrahim
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Ipagala P, Mlugu EM, Mwakalukwa R, Kagashe GA. Impact of COVID-19 on the supply chain of essential health commodities: a mixed method study, in Dar es Salaam, Tanzania. J Pharm Policy Pract 2023; 16:103. [PMID: 37736737 PMCID: PMC10515070 DOI: 10.1186/s40545-023-00617-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/16/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The outbreak of COVID-19 in the late 2019 led to major global health crises, including morbidities and mortalities. The pandemic has adversely affected the supply chain of essential health commodities globally. However, such data from sub-Saharan Africa including Tanzania are largely limited. We assessed the impact of COVID-19 on the supply chain of essential health commodities in Tanzania. METHOD A cross-sectional study with pragmatic mixed method design was conducted in Dar es Salaam region from January to June 2021. Grounded theory was adopted to purposeful select key informants (n = 15) from importers of essential health commodities and local pharmaceutical manufacturers. Community pharmacy dispensers (n = 242) were also recruited for the quantitative part of this study. The prices of selected tracer health commodities were extracted from the Tanzania Medicine and Medical Device Authority (TMDA) Regulatory Information Management system. The mean unit prices 1 year before the pandemic were compared with the mean prices 1 year during the pandemic using paired t test. Thematic analysis was used for qualitative data. RESULTS The information regarding the impact of COVID-19 on the supply chain of essential health commodities was synthesized into three main themes namely, reduced availability of health commodities, increased price of health commodities and increased lead time for imported essential health commodities during COVID-19. Majority (90%) of community pharmacy dispensers reported that COVID-19 reduced the availability of essential health commodities. Azithromycin, Paracetamol, Multivitamin and Vitamin C tablets were the highly demanded products and their mean unit prices increased significantly during COVID-19 as compared to 1 year before the pandemic (p < 0.05). CONCLUSIONS COVID-19 led to shortage, increased prices and delayed delivery of essential health commodities. This might happen in the future whenever unexpected crises causing disruption in the supply chain occur underscoring the need for the country preparedness measures.
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Affiliation(s)
- Pius Ipagala
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Eulambius M Mlugu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania.
| | - Rogers Mwakalukwa
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Godeliver A Kagashe
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
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Ledlie S, Tadrous M, McCormack D, Campbell T, Leece P, Kleinman RA, Kolla G, Besharah J, Smoke A, Sproule B, Gomes T. Assessing the impact of the slow-release oral morphine drug shortages in Ontario, Canada: A population-based time series analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104119. [PMID: 37429161 DOI: 10.1016/j.drugpo.2023.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/15/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Slow-release oral morphine (SROM) is used to manage pain, and as opioid agonist treatment (OAT). Between 2017 and 2021 in Canada, several drug shortages occurred for Kadian© (SROM-24). The purpose of this study was to evaluate the impact of these shortages on people's ability to remain on this medication. METHODS We conducted a retrospective population-based time series analysis of SROM-24 dispensed between January 1, 2014, and December 31, 2021, in Ontario, Canada. Using interventional autoregressive integrated moving average models (ARIMA) models, we evaluated the association between SROM-24 drug shortages and treatment discontinuation. Analyses were also stratified by the SROM-24 indication (pain or OAT). RESULTS We identified 22,479 SROM-24 recipients, of which one-third (33.9%) were aged 65 or above and just over half (51.9%) were female. In our primary analysis of monthly SROM-24 discontinuation, we observed a significant sustained monthly increase following the shortages in November 2019 (+0.29%/month; 95% CI: 0.16%, 0.43%; p < .001) with significant sudden, temporary changes following the shortages in March 2020 (+2.00%; 95% CI: 0.95%, 3.05%; p < .001), July 2021 (+3.53%; 95% CI: 2.20%, 4.86%; p < .001), and August 2021 (+4.98%; 95% CI: 3.49%, 6.47%; p < .001). Similar results were observed in our stratified analyses, with sustained high rates of discontinuation among people accessing SROM-24 as OAT. CONCLUSIONS The SROM-24 shortages resulted in significant treatment disruptions across all recipients. These findings have important implications for those with few treatment alternatives, including people using SROM-24 as OAT who are at risk of adverse outcomes following treatment disruptions.
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Affiliation(s)
- Shaleesa Ledlie
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | | | - Tonya Campbell
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
| | - Pamela Leece
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Kleinman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Kolla
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada; Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Jes Besharah
- Ontario Drug Policy Research Network Lived Experience Advisory Group, Toronto, Ontario, Canada
| | - Ashley Smoke
- Ontario Drug Policy Research Network Lived Experience Advisory Group, Toronto, Ontario, Canada
| | - Beth Sproule
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Hyatt A, Chan B, Moodie R, Varlow M, Bates C, Foliaki S, Palafox N, Burich S, Aranda S. Strengthening cancer control in the South Pacific through coalition-building: a co-design framework. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100681. [PMID: 37181526 PMCID: PMC10166990 DOI: 10.1016/j.lanwpc.2022.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
Background Cancer is a significant problem for the South Pacific region due to a range of complex health challenges. Currently gaps in diagnosis, treatment and palliative care are significant, and while governmental commitment is strong, economic constrains limit health system strengthening. Alliances have been successful in strengthening non-communicable disease and cancer control policy and services in resource constrained settings. A regional coalition approach has therefore been recommended as an effective solution to addressing many of the challenges for cancer control in the South Pacific. However, evidence regarding the effective mechanisms for development of alliances or coalitions is scarce. This study aimed to 1) create a Coalition Development Framework; 2) assess the use of the Framework in practice to co-design a South Pacific Coalition. Methods Creation of the Coalition Development Framework commenced with a scoping review and content analysis of existing literature. Synthesis of key elements formed an evidence-informed step-by-step guide for coalition-building. Application of the Framework comprised consultation and iterative discussions with key South Pacific cancer control stakeholders in Fiji, New Caledonia, Papua New Guinea, Samoa and Tonga. Concurrent evaluation of the Framework utilising Theory of Change (ToC) and qualitative analysis of stakeholder consultations was undertaken. Findings The finalised Coalition Development Framework comprised four phases with associated actions and deliverables: engagement, discovery, unification, action and monitoring. Application of the Framework in the South Pacific identified overwhelming support for a Cancer Control Coalition through 35 stakeholder consultations. Framework phases enabled stakeholders to confirm coalition design and purpose, strategic imperatives, structure, local foundations, barriers and facilitators, and priorities for action. ToC and thematic consultation analysis confirmed the Framework to be an effective mechanism to drive engagement, unification and action in alliance-building. Interpretation A Coalition to drive cancer control has significant support among key Pacific stakeholders, and establishment can now be commenced. Importantly results confirm the effective application of the Coalition Development Framework in an applied setting. If momentum is continued, and a regional South Pacific Coalition established, the benefits in reducing the burden of cancer within the region will be substantial. Funding This work was completed for a Masters of Public Health project. Cancer Council Australia provided project funding.
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Affiliation(s)
- Amelia Hyatt
- Cancer Control Policy, Cancer Council Australia, Sydney, NSW, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Rob Moodie
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Megan Varlow
- Cancer Control Policy, Cancer Council Australia, Sydney, NSW, Australia
| | - Chris Bates
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sunia Foliaki
- Research Centre for Hauora and Health, Massey University-Wellington Campus, Wellington, New Zealand
| | - Neal Palafox
- John A. Burns School of Medicine, University of Hawaii, University of Hawaii Cancer Center, Honolulu, United States
| | | | - Sanchia Aranda
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Nursing, University of Melbourne, Melbourne, VIC, Australia
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Shukar S, Zahoor F, Omer S, Awan SE, Yang C, Fang Y. Experience of Pharmacists with Anti-Cancer Medicine Shortages in Pakistan: Results of a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16373. [PMID: 36498446 PMCID: PMC9740989 DOI: 10.3390/ijerph192316373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to examine the current situation of anti-cancer drug shortages in Pakistan, namely its determinants, impacts, adopted mitigation strategies, and proposed solutions. Qualitative semi-structured, in-depth interviews were conducted with 25 pharmacists in oncology hospitals in Pakistan from August to October 2021. Data were collected in person and online, recorded, and subjected to inductive thematic analysis after being transcribed verbatim. Most participants experienced anti-cancer drug shortages that increased during the pandemic. Etoposide, paclitaxel, vincristine, dacarbazine, and methotrexate were frequently short. Important causes included the compromised role of regulatory authorities, lack of local production, and inventory mismanagement. The impacts were delayed/suboptimal treatment and out-of-pocket costs for patients, patients' prioritization, increased workload, negative work environment, and patients' trust issues for pharmacists. The participants proposed that a cautious regulator's role is needed to revise policies for all stakeholders and support all stakeholders financially at their level to increase access to these medicines. Based on the outcomes, it is clear that anti-cancer medicine shortages are a current issue in Pakistan. Governmental authorities need to play a role in revising policies for all levels of the drug supply chain and promoting local production of these drugs. Stakeholders should also collaborate and manage inventory.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Fatima Zahoor
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway 47500, Malaysia
| | - Sumaira Omer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Sundas Ejaz Awan
- Faculty of Pharmacy, Gadjah Mada University, Yogyakarta 55281, Indonesia
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
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Jaser S, Al Aamer K, Al Anizi A, Javed NB, AL-Mohaithef M. Ambulatory Care Pharmacist Perception of Formulary Medication Shortage: Tertiary Center Experience. Hosp Pharm 2022; 57:488-495. [PMID: 35898259 PMCID: PMC9310322 DOI: 10.1177/00185787211051645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Background: Medication shortage is a serious issue affecting public health and patient care. It causes a major burden on the medical team of a healthcare organization in the delivery of quality care. Objectives: This study aims to assess the perception of ambulatory care pharmacist about formulary medication shortage as well as to assess the rate of medication shortage and explore the highest classes of the not-available (NA) medication. Methods: A cross-sectional survey was performed to assess pharmacist perception regarding medication shortage. The data for NA medication was collected from the hospital health information system "HIS" (Best care) to investigate the type and classes of medication shortage. Results: The overall survey response rate was 92.7%. The majority (61%) of participants encountered 5 to 15 labels of NA medication per day, 43% of participants encountered unpleasant behavior from patients usually due to NA medication and the main reason of patient dissatisfaction was the negative effect of NA medication on their course of therapy. Ninety-seven percent of participants agreed that medication shortage adds extra pressure/workload and 66% agreed that medication shortage increases the chance of medication error. A total of 113 medication shortage was recorded between January and March 2020. The 2 drug classes, which showed maximum shortage, were gastrointestinal and cardiovascular medications. The most prevalent type of medication shortage was for drugs administered by oral route (91.2%). Conclusions: The study provides insights into the frequency, management, and problems confronted due to medication shortage from the pharmacist perception. The study findings highlight the classes and type of medication shortage in the hospital which needs intervention to enhance patient care. The findings of the study would help the higher administration to implement an effective strategy to mitigate the shortage of medication, improve patient satisfaction, and to reduce pharmacist workload.
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Affiliation(s)
- Saud Jaser
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Saudi Electronic University, Riyadh, Saudi Arabia
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Community Pharmacy Staff Knowledge, Opinion and Practice toward Drug Shortages in Saudi Arabia. Saudi Pharm J 2022; 29:1383-1391. [PMID: 35002375 PMCID: PMC8720696 DOI: 10.1016/j.jsps.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022] Open
Abstract
Drug shortages continue to pose a significant threat to public health and safety. Drug shortages not only worsen patient outcomes, but also significantly burden healthcare systems with additional costs. This study aimed to assess community pharmacy staff knowledge, opinion, and practice toward drug shortages in Saudi Arabia from November 2019 to March 2020. This was a cross-sectional study carried out among 1,008 community pharmacists from Saudi Arabia using a validated, self-administered and Internet-based survey. Analysis was done using chi square and fisher exact tests. Most participants were males (97.2%), less than 30 years old (48.1%), and non-Saudi citizens (94.4%), and 72.0% had good knowledge of drug shortages (score = 4–5). Around 36.0% reported that it takes 1–3 days to receive a response to the shortage report. There was a statistically significant association between the professional level of the community pharmacists and their opinion about reporting drug shortages (P < .05). Most community pharmacies (56.2%) did not receive any notification about drug shortages. In conclusion, most community pharmacists are knowledgeable and have good practice regarding drug shortages, but their opinions about drug shortages differ according to each pharmacy reporting policy.
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Fares J, Chung KSK, Abbasi A. Stakeholder theory and management: Understanding longitudinal collaboration networks. PLoS One 2021; 16:e0255658. [PMID: 34648505 PMCID: PMC8516199 DOI: 10.1371/journal.pone.0255658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/21/2021] [Indexed: 11/18/2022] Open
Abstract
This paper explores the evolution of research collaboration networks in the ‘stakeholder theory and management’ (STM) discipline and identifies the longitudinal effect of co-authorship networks on research performance, i.e., research productivity and citation counts. Research articles totaling 6,127 records from 1989 to 2020 were harvested from the Web of Science Database and transformed into bibliometric data using Bibexcel, followed by applying social network analysis to compare and analyze scientific collaboration networks at the author, institution and country levels. This work maps the structure of these networks across three consecutive sub-periods (t1: 1989–1999; t2: 2000–2010; t3: 2011–2020) and explores the association between authors’ social network properties and their research performance. The results show that authors collaboration network was fragmented all through the periods, however, with an increase in the number and size of cliques. Similar results were observed in the institutional collaboration network but with less fragmentation between institutions reflected by the increase in network density as time passed. The international collaboration had evolved from an uncondensed, fragmented and highly centralized network, to a highly dense and less fragmented network in t3. Moreover, a positive association was reported between authors’ research performance and centrality and structural hole measures in t3 as opposed to ego-density, constraint and tie strength in t1. The findings can be used by policy makers to improve collaboration and develop research programs that can enhance several scientific fields. Central authors identified in the networks are better positioned to receive government funding, maximize research outputs and improve research community reputation. Viewed from a network’s perspective, scientists can understand how collaborative relationships influence research performance and consider where to invest their decision and choices.
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Affiliation(s)
- Julian Fares
- Department of Management Studies, Adnan Kassar School of Business, Lebanese American University, Beirut, Lebanon
- * E-mail:
| | - Kon Shing Kenneth Chung
- School of Project Management, Faculty of Engineering, The University of Sydney, Sydney, Australia
| | - Alireza Abbasi
- School of Engineering and IT, University of New South Wales (UNSW), Canberra, Australia
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A Qualitative Study Exploring the Management of Medicine Shortages in the Community Pharmacy of Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010665. [PMID: 34682409 PMCID: PMC8535806 DOI: 10.3390/ijerph182010665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 01/22/2023]
Abstract
Managing medicine shortages consumes ample time of pharmacists worldwide. This study aimed to explore the strategies and resources being utilized by community pharmacists to tackle a typical shortage problem. Qualitative face-to-face interviews were conducted. A total of 31 community pharmacists from three cities (Lahore, Multan, and Dera Ghazi Khan) in Pakistan were sampled, using a purposive approach. All interviews were audio taped, transcribed verbatim, and subjected to thematic analysis. The analysis yielded five broad themes and eighteen subthemes. The themes highlighted (1) the current scenarios of medicine shortages in a community setting, (2) barriers encountered during the shortage management, (3) impacts, (4) corrective actions performed for handling shortages and (4) future interventions. Participants reported that medicine shortages were frequent. Unethical activities such as black marketing, stockpiling, bias distribution and bulk purchasing were the main barriers. With respect to managing shortages, maintaining inventories was the most common proactive approach, while the recommendation of alternative drugs to patients was the most common counteractive approach. Based on the findings, management strategies for current shortages in community pharmacies are insufficient. Shortages would continue unless potential barriers are addressed through proper monitoring of the sale and consumption of drugs, fair distribution, early communication, and collaboration.
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Atif M, Sehar A, Malik I, Mushtaq I, Ahmad N, Babar ZUD. What impact does medicines shortages have on patients? A qualitative study exploring patients' experience and views of healthcare professionals. BMC Health Serv Res 2021; 21:827. [PMID: 34404420 PMCID: PMC8369330 DOI: 10.1186/s12913-021-06812-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 07/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background The shortage of medicines represents a complex global phenomenon that triggers patient care and safety issues. The study was undertaken to explore the impact of medicines shortages on patients in Pakistan. The study also identified barriers which hinder the solutions of medicines shortages issue. Methods A qualitative study design was adopted and the data was collected in stages between July and September 2019using an in-depth interview approach. The purposive and convenient sampling strategy was used to recruit the study participants. Sample size was limited by using the saturation point criteria. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results A total of 35 stakeholders including 13 physicians, 12 pharmacists and 10 patients participated in the study. The findings of the study were classified into five key themes and seven subthemes. The five themes included, ‘impact of medicine shortages on patients’, ‘patients’ practices in response to medicine shortages’, ‘influence of medicines shortages on medical practice or pharmaceutical business’, ‘barriers to solutions for medicines shortages’, and ‘suggestions to assuage the impact of medicine shortages.’This study showed that the medicine shortages had significant clinical and financial impact on patients. Patients’ opted for a number of risk-prone practices to avoid treatment disruption during shortages. An array of pharmaceutical market, medicines quality and patient related factors refrain physicians to switch from brand name medicine to generics and lead to ineffective management of medicines shortages. Promotion of generic prescription, implementation of punitive policies and proper patient consultation was advised to assuage the impact of medicine shortages on patients. Conclusion The adverse clinical, economic and humanistic impact affirmed in this study demand the introduction of risk-management strategies for medicines shortages in hospital and community settings in accordance with the international standards. Promotion of effective patient counselling by the healthcare professionals to deter risk-prone practices associated with medicines shortages is mandatory. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06812-7.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Azka Sehar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Irem Mushtaq
- Department of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
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Shukar S, Zahoor F, Hayat K, Saeed A, Gillani AH, Omer S, Hu S, Babar ZUD, Fang Y, Yang C. Drug Shortage: Causes, Impact, and Mitigation Strategies. Front Pharmacol 2021; 12:693426. [PMID: 34305603 PMCID: PMC8299364 DOI: 10.3389/fphar.2021.693426] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Fatima Zahoor
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Sumaira Omer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
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Moral reasoning perspectives of community pharmacists in situations of drug shortages. Res Social Adm Pharm 2020; 18:2424-2431. [PMID: 33349586 DOI: 10.1016/j.sapharm.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Drug shortages affect health systems worldwide. Research in community pharmacy has focused on the nature, extent and impact of these shortages on patients and pharmacists. However, pharmacists' moral reasoning in situations of drug shortages has not been addressed. OBJECTIVE To explore the moral reasoning perspectives of Dutch community pharmacists in situations of drug shortages. METHOD An electronic survey was developed around three drug shortage scenarios with a varying impact on patient outcomes: a Contraceptive, a Parkinson's and an Osteoporosis scenario. Pharmacists rated the likelihood of nine handling options and rated and ranked 13 considerations that may have played a role therein. The considerations represented three moral reasoning perspectives (MRPs): a business orientation (BO), a rules and regulations (RR), and a professional ethics (PE) MRP. Principle component analysis (PCA) was used to investigate construct validity of the MRPs. MRP rating and MRP ranking scores measured the relative importance of the different MRPs of pharmacists in the three shortages. RESULTS Results from 267 Pharmacists were obtained. They reported mostly similar handling in the three shortages, except for the likelihood to make agreements with prescribers or other pharmacists and regarding the decision to import a product. The PCA analysis confirmed the three MRPs that accounted for 29% of variance in the data. Both the MRP rating and especially the MRP ranking scores indicated that PE-MRP considerations were most influential on pharmacists' intended handling of the shortages. In the Contraceptive and the Osteoporosis scenarios, the relative importance of a BO-MRP was higher than in the Parkinson's scenario. CONCLUSION Pharmacists predominantly reason with a PE-MRP when handling drug shortages. However, this perspective can be compromised when the drug shortage is perceived to have a lower impact on patient outcomes and when alternative drugs or therapy are expensive.
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Global drug shortages due to COVID-19: Impact on patient care and mitigation strategies. Res Social Adm Pharm 2020; 17:1946-1949. [PMID: 32446652 PMCID: PMC7235598 DOI: 10.1016/j.sapharm.2020.05.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 11/25/2022]
Abstract
Coronavirus disease 2019 (COVID-19) arising from Wuhan, China, is currently outbreaking worldwide. The World Health Organization (WHO) has declared COVID-19 to be a global pandemic. COVID-19 could cause a wide range of symptoms ranging from self-limiting fever, sore throat, and cough to more severe symptoms that could lead to acute respiratory distress syndrome. As a result of the lockdown and increased demand, drug shortages could become a growing global issue. This article aims to shed light on the potential impact of drug shortages as a result of this pandemic on patient outcomes and the role of pharmacists and pharmacy policymakers in alleviating this emerging problem.
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16
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Muthathi IS, Levin J, Rispel LC. Decision space and participation of primary healthcare facility managers in the Ideal Clinic Realisation and Maintenance programme in two South African provinces. Health Policy Plan 2020; 35:302-312. [PMID: 31872256 PMCID: PMC7152727 DOI: 10.1093/heapol/czz166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 02/05/2023] Open
Abstract
In South Africa, the introduction of a national health insurance (NHI) system is the most prominent health sector reform planned to achieve universal health coverage in the country. Primary health care (PHC) is the foundation of the proposed NHI system. This study draws on policy implementation theory and Bossert's notion of decision space to analyse PHC facility managers' decision space and their participation in the implementation of the Ideal Clinic Realisation and Maintenance (ICRM) programme. We conducted a cross-sectional survey among 127 PHC facility managers in two districts in Gauteng and Mpumalanga provinces. A self-administered questionnaire elicited socio-demographic information, the PHC managers' participation in the conceptualization and implementation of the ICRM programme, their decision space and an optional open-ended question for further comments. We obtained a 100% response rate. The study found that PHC facility managers reported lack of involvement in the conceptualization of the ICRM programme, high levels of participation in implementation [mean score 5.77 (SD ±0.90), and overall decision space mean score of 2.54 (SD ±0.34)]. However, 17 and 21% of participants reported narrow decision space on the critical areas of the availability of essential medicines and on basic resuscitation equipment respectively. The qualitative data revealed the unintended negative consequences of striving for 'ideal clinic status', namely that of creating an illusion of compliance with the ICRM standards. The study findings suggest the need for greater investment in the health workforce, special efforts to involve frontline managers and staff in health reforms, as well as provision of adequate resources, and an enabling practice environment.
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Affiliation(s)
- Immaculate Sabelile Muthathi
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
| | - Laetitia C Rispel
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
- Centre for Health Policy & Department of Science and Innovation/National Research Foundation Research Chair, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
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17
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Modisakeng C, Matlala M, Godman B, Meyer JC. Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications. BMC Health Serv Res 2020; 20:234. [PMID: 32192481 PMCID: PMC7082963 DOI: 10.1186/s12913-020-05080-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicine shortages are a complex global challenge affecting all countries. This includes South Africa where ongoing medicine shortages are a concern among public sector hospitals as South Africa strives for universal access to healthcare. The objectives of this research were to highlight challenges in the current pharmaceutical procurement process for public sector hospitals. Subsequently, suggest potential ways forward based on the findings as the authorities in South Africa seek to improve the procurement process. METHOD Qualitative in-depth interviews were conducted with 10 pharmacy managers in public sector hospitals in the Gauteng Province, South Africa. A thematic content analysis was performed, with transcripts coded by two of the authors. Coding was discussed until consensus was reached. Categories were developed and grouped into themes. RESULTS The 'Procurement process' emerged from the data as the overarching theme, rooted in three main themes: (i) The buy-out process that was used to procure medicines from suppliers other than the contracted ones; (ii) Suppliers not performing thereby contributing to medicine shortages in the hospitals; and (iii) Challenges such as the inaccuracy of the electronic inventory management system used in the hospitals. CONCLUSIONS Effective management of contracts of suppliers by the Provincial Department of Health is crucial to ensure accessibility and availability of essential medicines to all citizens of South Africa. Ongoing monitoring and support for the future use of computerised inventory management systems is important to reduce medicine shortages, and this is being followed up.
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Affiliation(s)
- Cynthia Modisakeng
- Department of Pharmacy, Dr George Mukhari Academic Hospital, Private Bag, Pretoria, South Africa.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Moliehi Matlala
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow, UK
| | - Johanna Catharina Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
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18
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AlAzmi AA, Jastaniah W, Alhamdan HS, AlYamani AO, AlKhudhyr WI, Abdullah SM, AlZahrani M, AlSahafi A, AlOhali TA, Alkhelawi T, AlObaida Y, Allam A, Al-Hashmi H, Murshid E, AlNajjar F, AlGethami A, AlHarbi A, AlFoheidi MO, AlSaeed AS, Elsolh H, Abosoudah I, Ben Obaid A, AlNahedh M. Addressing Cancer Treatment Shortages in Saudi Arabia: Results of a National Survey and Expert Panel Recommendations. JCO Glob Oncol 2020; 6:476-485. [PMID: 32202921 PMCID: PMC7113076 DOI: 10.1200/jgo.19.00230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Cancer treatment shortages are complex and a persistent problem worldwide. Patients with cancer are most vulnerable to drug shortages, which provides opportunities to examine the extent of the challenge(s) facing Saudi Arabia and to provide recommendations toward mitigating the impact of cancer treatment shortages on patient outcomes. MATERIALS AND METHODS A qualitative methodologic approach was conducted in April 2019 using a validated questionnaire and structured panel discussion for data generation. RESULTS Overall, 55 responses were received from practicing oncology health care professionals (26 pharmacists and 29 physicians). The annual average number of treated patients with cancer per institution was 640 (adults [n = 400] and pediatric [n = 240]). All respondents (100%) reported that cancer treatment shortages constitute a current problem in their center, with an average of 5 (range, 1-9) per month. The panelists recognized 2 fundamental points. First, the definition of cancer drug shortages should be standardized and recognized at the national level. Second, the current system must be improved to ensure proper and efficient use of the current resources. On that basis, the panelists developed 9 recommendations for action. CONCLUSION Cancer drug shortage is a significant problem in all health centers in Saudi Arabia. This study presents challenges that should be addressed at the national level and essential consensus recommendations for a coordinated action developed by a panel of experts to tackle the current national problem of cancer treatment shortages. Implementing these recommendations will provide a blueprint for management of national drug shortages in general and cancer treatment shortages in particular.
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Affiliation(s)
- Aeshah A. AlAzmi
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Kingdom of Saudi Arabia
- Department of Clinical Pharmacy, Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Wasil Jastaniah
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Kingdom of Saudi Arabia
| | - Hani S. Alhamdan
- Pharmaceutical Care Services Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Arwa O. AlYamani
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Kingdom of Saudi Arabia
- Oncology Quality & Patient Safety, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | | | - Shaker M. Abdullah
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Kingdom of Saudi Arabia
| | - Mohammed AlZahrani
- Medical Services, Ministry of National Guard Health Affairs, Western Region, Kingdom of Saudi Arabia
| | - Ashraf AlSahafi
- Clinical Services, Ministry of National Guard Health Affairs, Western Region, Kingdom of Saudi Arabia
| | - Tawfiq A. AlOhali
- National Unified Procurement Company, Riyadh, Kingdom of Saudi Arabia
| | - Trad Alkhelawi
- Policy & Market Access in Gulf Cooperation Council, Amgen, Kingdom of Saudi Arabia
| | | | | | - Hani Al-Hashmi
- Oncology Center, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Essam Murshid
- Department of Medical/Radiation Oncology, Prince Sultan Medical Military City, Riyadh, Kingdom of Saudi Arabia
| | - Fouad AlNajjar
- Pharmaceutical Care Services Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ashwag AlGethami
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- Department of Clinical Pharmacy, Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Atika AlHarbi
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- Department of Clinical Pharmacy, Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Meteb O. AlFoheidi
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- Saudi Oncology Society, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad S. AlSaeed
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- Saudi Scientific Society of Blood and Marrow Transplantation, Riyadh, Kingdom of Saudi Arabia
| | - Hassan Elsolh
- Medical Affairs, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ibraheem Abosoudah
- King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
- Saudi Arabian Pediatric Hematology Oncology Society, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Ben Obaid
- Pharmaceutical Care Services Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
- Saudi Oncology Pharmacy Assembly, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed AlNahedh
- Department of Pharmaceutical Care, Oncology Pharmacy Services, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
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Abstract
In this article, I investigate how diabetes-related risks are experienced and managed in Fiji. Neoliberal discourses implore patients to be risk-averse and blame poorer Indigenous (iTaukei) people with diabetes for "irresponsible" treatment choices and medication "noncompliance." Drawing on ethnographic fieldwork conducted during 2015-16, I suggest lower-income iTaukei people with diabetes face multiple layers of risk in everyday life beyond biomedical definitions, including spiritual threats; cultural politics; and limited healthcare access. People with diabetes pragmatically weigh up these risks when choosing whether to seek treatment, be it biomedical, faith-based, pharmaceutical, or herbal remedies. Better understanding how patients experience and manage risk will improve diabetes care.
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Affiliation(s)
- Tarryn Phillips
- Department of Social Inquiry, La Trobe University , Melbourne, Australia
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20
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Lee BY, Wedlock PT, Mitgang EA, Cox SN, Haidari LA, Das MK, Dutta S, Kapuria B, Brown ST. How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India. BMJ Glob Health 2019; 4:e001609. [PMID: 31565408 PMCID: PMC6747917 DOI: 10.1136/bmjgh-2019-001609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/06/2019] [Accepted: 08/10/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Coping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader impact of coping. Methods We developed a computational simulation model of Bihar, India’s routine immunisation supply chain where coping (ie, making additional vaccine shipments above stated policy) occurs. We simulated the impact of coping by allowing extra trips to occur as needed up to one time per day and then limiting coping to two times per week and three times per month before completely eliminating coping. Results Coping as needed resulted in 3754 extra vaccine shipments over stated policy resulting in 56% total vaccine availability and INR 2.52 logistics cost per dose administered. Limiting vaccine shipments to two times per week reduced shipments by 1224 trips, resulting in a 7% vaccine availability decrease to 49% and an 8% logistics cost per dose administered increase to INR 2.73. Limiting shipments to three times per month reduced vaccine shipments by 2635 trips, which decreased vaccine availability by 19% to 37% and increased logistics costs per dose administered by 34% to INR 3.38. Completely eliminating coping further reduced shipments by 1119 trips, decreasing total vaccine availability an additional 24% to 13% and increasing logistics cost per dose administered by 169% to INR 9.08. Conclusion Our results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.
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Affiliation(s)
- Bruce Y Lee
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland, USA.,Public Health Informatics, Computational, and Operations Research (PHICOR), Baltimore, Maryland and New York City, New York, USA
| | - Patrick T Wedlock
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland, USA.,Public Health Informatics, Computational, and Operations Research (PHICOR), Baltimore, Maryland and New York City, New York, USA
| | - Elizabeth A Mitgang
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland, USA.,Public Health Informatics, Computational, and Operations Research (PHICOR), Baltimore, Maryland and New York City, New York, USA
| | - Sarah N Cox
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland, USA.,Public Health Informatics, Computational, and Operations Research (PHICOR), Baltimore, Maryland and New York City, New York, USA
| | - Leila A Haidari
- Public Health Informatics, Computational, and Operations Research (PHICOR), Baltimore, Maryland and New York City, New York, USA.,HERMES Logistics Team, Pittsburgh, Pennsylvania and Baltimore, Maryland, USA
| | | | | | | | - Shawn T Brown
- HERMES Logistics Team, Pittsburgh, Pennsylvania and Baltimore, Maryland, USA.,McGill Center for Integrative Neuroscience, McGill University, Montreal, Quebec, Canada
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21
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Atif M, Malik I, Mushtaq I, Asghar S. Medicines shortages in Pakistan: a qualitative study to explore current situation, reasons and possible solutions to overcome the barriers. BMJ Open 2019; 9:e027028. [PMID: 31488466 PMCID: PMC6731845 DOI: 10.1136/bmjopen-2018-027028] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study was conducted to assess current situation of medicines shortages in Pakistan and to identify its impact, reasons and possible solutions to overcome the barriers. DESIGN A qualitative study. SETTING The study was conducted between May 2018 and July 2018 in three cities of Pakistan including Islamabad, Karachi and Bahawalpur, depending on the availability of most relevant key informants. PARTICIPANTS Health regulators, pharmaceutical manufacturers, pharmaceutical distributors and pharmacists. PRIMARY AND SECONDARY OUTCOME MEASURE Study primarily explored current situation, reasons and potential solutions of medicines shortages in Pakistan. Secondary outcome was the issue of particular brand shortage. METHOD Semistructured interviews were conducted. Sample size was determined by using saturation point criteria. Convenient sampling techniques were used to recruit the participants. The interviews were audiorecorded and transcribed verbatim. Data were analysed using inductive thematic analysis. RESULTS A total of 41 stakeholders including 12 health regulators, 6 pharmaceutical manufacturers, 8 pharmaceutical distributors and 15 pharmacists participated in this study. Data analysis yielded 4 themes, 16 subthemes, 51 categories. Essential and life-saving medicines were in short supply. The major reasons of short supply of medicines were active pharmaceutical ingredient and raw material availability issues, lack of traditional distribution system and sudden demand fluctuation. Among proposed solutions, three most common were the facilitation and regulation of manufacturers, reasonable price fixation and improvements in the inventory control system. CONCLUSION Medicines were short in supply, and this may have clinical and financial impact on the patients in Pakistan. There were multiple and complex reasons of medicines shortages. Mandatory government leadership is required to resolve the issue on priority basis for improving the access of medicines to the patients.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy, Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Irem Mushtaq
- Department of Education, Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Saima Asghar
- Department of Pharmacy, Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Acosta A, Vanegas EP, Rovira J, Godman B, Bochenek T. Medicine Shortages: Gaps Between Countries and Global Perspectives. Front Pharmacol 2019; 10:763. [PMID: 31379565 PMCID: PMC6658884 DOI: 10.3389/fphar.2019.00763] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Over the last decade, global health policies and different research areas have focused on the relevance and impact of medicine shortages. Published studies suggest there have been difficulties with access to medicines since the beginning of the 20th century, and there have been advances in our understanding and management of the problem since then. However, in view of global and regional health care concerns with shortages, we believe this phenomenon needs to be characterized and described more fully regarding the types of medicines affected, possible causes, and potential strategies to address these. The aim of this scoping review was to identify, compare if possible, and characterize the recent literature regarding the situation of medicines shortages between countries, and provide different perspectives, including a global context and national approaches. Methodology: A scoping study presented as a narrative review of the situation and findings principally based on published articles. Results: Based on the reported cases in the literature, a typology of medicines shortage and supply interruption episodes and their causes were proposed; national approaches to notify and manage the medicines shortages cases were described and classified by update frequency; principal differences between market and supply chain management perspectives of the situation were identified and global and countries’ perspectives were described. Conclusion: Policy makers require solutions that prevent those cases in which the population’s health is affected by episodes of medicine shortages and/or interruption in the supply chain. There is also a need to generate a glossary related to logistics management and the availability of medicines which will be useful to understand and overcome shortages. In addition, recognize that potential solutions are not only related with actions linked to research, development and innovation, but much wider. Overall, we believe this article can act as a basis for future discussions in this important area.
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Affiliation(s)
- Angela Acosta
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,RAM Group, National University of Colombia, Bogotá, Colombia
| | - Egdda Patricia Vanegas
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,SEPRO Research Group, National University of Colombia, Bogotá, Colombia
| | - Joan Rovira
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,Andalusian School of Public Health, Granada, Spain
| | - Brian Godman
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Tomasz Bochenek
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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23
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AlAzmi A, AlRashidi F. Medication Exchange and Sharing Network Program (MESNP) initiative to cope with drug shortages in the Kingdom of Saudi Arabia (KSA). Risk Manag Healthc Policy 2019; 12:115-121. [PMID: 31372073 PMCID: PMC6628954 DOI: 10.2147/rmhp.s198375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
Background Drug shortages are a major public health concern and remain a persistent problem worldwide. At present, there are no unified existing strategies for managing medicine stocks in the Kingdom of Saudi Arabia (KSA). Here, the aim is to describe our experience with creating a non-profit voluntary national Medication Exchange and Sharing Network Program (MESNP) throughout the KSA. Methods A quality improvement process map method was used in this project. The baseline evaluation included a review of possible reasons and strategies for managing medication shortages and recognizing potential associated safety issues. To that end, at the national level, we developed MESNP as a novel project to cope with medication shortages using Telegram social media as the preferred program for connecting with the member institution. Results A total of 500 requests were received over one year. Three hundred and fifteen (315) constituted requests for drug supplies due to shortages while the number of reports indicating the availability of overstock drug for re-distribution is (185). Almost 98% of overstocking drug reports was re-distributed in which it covers 75% of drug shortage requests. Conclusion This novel project aims to use our current resources by facilitating the medication exchange and sharing between the organizations at national level. The optimistic goal is to proactively mitigate drug wastages and prevent drug shortages toward better patient care.
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Affiliation(s)
- Aeshah AlAzmi
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC 6255), Pharmaceutical Care Services Department, Clinical Pharmacy Section, Jeddah 21423, Saudi Arabia
| | - Faris AlRashidi
- King Fahad Specialist Hospital (KFSH), Pharmaceutical Care Services Department, Dammam, Saudi Arabia
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24
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The impacts of medication shortages on patient outcomes: A scoping review. PLoS One 2019; 14:e0215837. [PMID: 31050671 PMCID: PMC6499468 DOI: 10.1371/journal.pone.0215837] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/09/2019] [Indexed: 12/29/2022] Open
Abstract
Background In recent years, medication shortages have become a growing worldwide issue. This scoping review aimed to systematically synthesise the literature to report on the economic, clinical, and humanistic impacts of medication shortages on patient outcomes. Methods Medline, Embase, Global Health, PsycINFO and International Pharmaceutical Abstracts were searched using the two key concepts of medicine shortage and patient outcomes. Articles were limited to the English language, human studies and there were no limits to the year of publication. Manuscripts included contained information regarding the shortage of a scheduled medication and had gathered data regarding the economic, clinical, and/or humanistic outcomes of drug shortages on human patients. Findings We found that drug shortages were predominantly reported to have adverse economic, clinical and humanistic outcomes to patients. Patients were more commonly reported to have increased out of pocket costs, rates of drug errors, adverse events, mortality, and complaints during times of shortage. There were also reports of equivalent and improved patient outcomes in some cases. Conclusions The results of this review provide valuable insights into the impact drug shortages have on patient outcomes. The majority of studies reported medication shortages resulted in negative patient clinical, economic and humanistic outcomes.
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25
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Bochenek T, Abilova V, Alkan A, Asanin B, de Miguel Beriain I, Besovic Z, Vella Bonanno P, Bucsics A, Davidescu M, De Weerdt E, Duborija-Kovacevic N, Fürst J, Gaga M, Gailīte E, Gulbinovič J, Gürpınar EU, Hankó B, Hargaden V, Hotvedt TA, Hoxha I, Huys I, Inotai A, Jakupi A, Jenzer H, Joppi R, Laius O, Lenormand MC, Makridaki D, Malaj A, Margus K, Marković-Peković V, Miljković N, de Miranda JL, Primožič S, Rajinac D, Schwartz DG, Šebesta R, Simoens S, Slaby J, Sović-Brkičić L, Tesar T, Tzimis L, Warmińska E, Godman B. Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries. Front Pharmacol 2018; 8:942. [PMID: 29403372 PMCID: PMC5779072 DOI: 10.3389/fphar.2017.00942] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022] Open
Abstract
Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed.
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Affiliation(s)
- Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vafa Abilova
- Analytical Expertise Centre, Ministry of Health, Baku, Azerbaijan
| | - Ali Alkan
- Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Bogdan Asanin
- Department of Surgery, Department of Medical Ethics, Medical Faculty of the University of Montenegro, Podgorica, Montenegro
| | | | - Zeljka Besovic
- Montenegrin Agency for Drugs and Medical Devices, Sector for Drugs and Medical Devices, Podgorica, Montenegro
| | - Patricia Vella Bonanno
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products, Brussels, Belgium
| | | | - Elfi De Weerdt
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Natasa Duborija-Kovacevic
- Department of Pharmacology and Clinical Pharmacology, Medical Faculty of the University of Montenegro, Podgorica, Montenegro
| | - Jurij Fürst
- Department of Medicines, Health Insurance Institute, Ljubljana, Slovenia
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | | | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, Vilnius, Lithuania.,State Medicine Control Agency, Vilnius, Lithuania
| | - Emre U Gürpınar
- Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Balázs Hankó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Vincent Hargaden
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | | | - Iris Hoxha
- Department of Pharmacy, University of Medicine, Tirana, Albania
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Andras Inotai
- Syreon Research Institute, Budapest, Hungary.,Department of Health Policy and Health Economics, Institute of Economics, Eötvös Loránd University, Budapest, Hungary
| | - Arianit Jakupi
- Department of Drug Management, Faculty of Pharmacy, UBT (Kosovo), Prishtina, Albania
| | - Helena Jenzer
- Health Department, Bern University of Applied Sciences, Bern, Switzerland.,University Hospital of Psychiatry Zurich (PUK), Zurich, Switzerland
| | - Roberta Joppi
- Local Health Unit of Verona-Veneto Region, Verona, Italy
| | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | | | - Despina Makridaki
- Panhellenic Association of Hospital Pharmacists, Athens, Greece.,National Organization for Medicines, Athens, Greece
| | - Admir Malaj
- Department of Pharmacy, University of Medicine, Tirana, Albania
| | - Kertu Margus
- Estonian State Agency of Medicines, Tartu, Estonia
| | - Vanda Marković-Peković
- Ministry of Health and Social Welfare, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka (Republic of Srpska), Banja Luka, Bosnia and Herzegovina
| | | | - João L de Miranda
- Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Portalegre, Portalegre, Portugal.,Centro de Recursos Naturais e Ambiente, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Stanislav Primožič
- Agency for Medicinal Products and Medicinal Devices, Ljubljana, Slovenia
| | | | - David G Schwartz
- Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Juraj Slaby
- State Institute for Drug Control, Prague, Czechia
| | | | - Tomas Tesar
- Department of Organisation and Management in Pharmacy, Pharmaceutical Faculty, Comenius University, Bratislava, Slovakia
| | | | - Ewa Warmińska
- Dentons Europe Dąbrowski i Wspólnicy sp. k., Warszawa, Poland
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Clinical Pharmacology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Health Economics Centre, Liverpool University Management School, Liverpool, United Kingdom
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