Results of EAHP's 2023 shortages survey

AIMS AND OBJECTIVE

The aim of the European Association of Hospital Pharmacists (EAHP)'s 2023 shortages survey was to collect data on causes and mitigation strategies of shortages of medicines and medical devices and their impact on patient care. The survey targeted hospital pharmacists (HPs), physicians (PHYs), nurses (NRS) and other healthcare professionals (OHCPs). A separate set of questions addressed patients (PTNs).

METHODS

A 49-question survey was carried out by a team at EAHP, collecting information from European HPs, PTNs, NRS, PHYs and OTHCs on shortages of medicines and medical devices in their respective countries. The survey ran from 27 February to 19 May 2023. The results were analysed by EAHP.

RESULTS

There were 1497 HP responses to the 2023 survey. While 95% (n=1429) of HPs and 86% (n=127) of OHCPs consider medicine shortages an ongoing problem, 84% (n=48) of PHYs and 68% (n=15) of NRS also agreed. Shortages of active pharmaceutical ingredients (77%, n=1148), manufacturing (67%, n=1007) and supply chain problems (50%, n=752) are major causes of shortages according to HPs as well as NRS and OHCPs; PHYs (49%, n=18) consider pricing to be the driver. More than 60% (n=765) of HPs, 55% (n=11) of NRS, 57% (n=30) of PHYs and 46% (n=56) of OHCPs experienced shortages of medical devices in 2022. Antimicrobials were most affected, according to all respondent groups, followed by analgesics, anaesthetics, cardiovascular and paediatric medicines. HPs (59%, n=269), NRS (57%, n=4), OHCPs (56%, n=37) and PHYs (54%, n=14) consider delays in care as the main consequence of medication shortages.

CONCLUSIONS

Shortages of medicines and medical devices affect healthcare services and patient care. Increased transparency and access to information regarding ongoing and emerging shortages as well as better preparedness of healthcare professionals is crucial to their effective management.

Lessons learnt from the COVID-19 pandemic: results of EAHP survey on the future crisis preparedness of hospital pharmacies

Aim

The present survey aimed to collect information on the lessons learnt from the COVID-19 pandemic by hospital pharmacists. It focused on the shortages of health goods and the experiences of hospitals during the first phase of the crisis.

Methods

A 17-question survey was conducted by EAHP, looking at the experiences of hospital pharmacists during the COVD-19 pandemic. The survey ran from 16 September to 23 December 2020. Statistical analysis included backward stepwise logistic regression (BSLR), Pearson’s χ² test, t-test and one-way ANOVA, as appropriate; p≤0.05 was considered statistically significant.

Results

1466 hospital pharmacists answered the survey fully. 58%, 63% and 69% of them experienced shortages in medicines, disinfectants and personal protective equipment (PPE), respectively. BSLR showed that being a COVID-19 dedicated hospital increased the risk of medicine shortages (OR 1.63, 95% CI 1.15 to 2.31) but the shortages of disinfectants and PPE were lower (OR 0.62, 95% CI 0.44 to 0.88; OR 0.60, 95% CI 0.42 to 0.85). Being a specialised hospital reduced the odds of medicine shortages (OR 0.59, 95% CI 0.40 to 0.88), while countries with a greater percentage of the population infected had increased odds for all three types of shortages (OR 1.16, 95% CI 1.01 to 1.23; OR 1.34, 95% CI 1.19 to 1.50; OR 1.21, 95% CI 1.09 to 1.35). The odds were also higher in answers submitted in September compared with December. The classes of medicines with highest reported shortages were anaesthetics, antibiotics and muscle relaxants. The main entities that provided support were the national competent authorities and manufacturers.

Conclusion

Medicine shortages affected the work of hospital pharmacists during the early stages of the pandemic. The features of the crisis and the feedback described in this survey can provide interesting insights for a more resilient healthcare framework in the future.

The European COVID-19 drugs calculation tool: an aid for the estimation of the drugs needed during the SARS-CoV 2 pandemic

Objective

To create an informatics supportive tool, which can assist healthcare professionals in estimating potential requirements for essential drug supplies to respond to the current SARS-CoV-2 pandemic based on epidemiological forecasting.

Methods

The tool was based on a Susceptible-Infected-Removed (SIR) epidemiological model in which the population is divided into three compartments and transmission parameters are specified to define the rate at which people move between stages. Appropriate data entry was guaranteed by the creation of structured guided paths. The drugs needed for the forecasted patients were estimated according to a list of critical care drugs compiled by consulting previous published scientific works, national and international guidelines. For each drug, an estimation was made of the percentage average ICU uptake for each therapeutic group and active principle.

Results

The tool consists of a Microsoft Excel template that is based on the initial epidemiological situation, the non-pharmaceutical interventions applied, the risk of hospitalisation based on the population age distribution, and the hospital beds available. The tool provides a forecast of which patients with COVID-19 will need to be treated in a hospital setting. The number of patients is used to estimate the drugs needed based on the average daily dose and the treatment length of each drug. The possibility of editing the type of distribution (exponential or linear) of the number of patients at the beginning of the analysis, the percentage adherence with non-pharmaceutical interventions and their delayed effect, and all the key epidemiological parameters make the estimation tailorable to different clinical contexts and needs.

Conclusions

This model might be an effective supporting tool that could be easily implemented within the workflow of health professionals. All the information reported in this paper could be useful in developing new strategies to tackle the COVID-19 pandemic.

Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries

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.

Recombinant human erythropoietin for platinum-based chemotherapy-induced anaemia: A single-centre randomised study

PURPOSE

Recombinant human erythropoietin (rHuEPO) represents an attractive alternative to red blood cell (RBC) transfusions for the treatment of chemotherapy-induced anaemia. This prospective, controlled study evaluated the safety and efficacy of rHuEPO in reducing RBC transfusion requirements in patients receiving platinum-based chemotherapy.

PATIENTS AND METHODS

Patients with histologically proven malignancies, haemoglobin (Hb) values <10.5 g/dl, and receiving platinum-based chemotherapy were randomised to either 150 IU/kg of rHuEPO subcutaneously (s.c.) x3/week (group A), or simple follow-up plus RBC transfusions upon indication (group B). All patients received 200mg of elementary iron (Fe) daily.

RESULTS

A total of 47 patients were randomised to either group A (n=24) or the control group B (n=23). There was a statistically significant increase of Hb (p <0.0002) and haematocrit (Ht) (p <0.002) in group A patients compared to the control group B. The levels of Hb in group A patients increased significantly with each chemotherapy cycle number. There was a statistically significant (p <0.04) difference in the number of transfusions between the two groups, with only 37.5% of group A patients requiring a RBC transfusion at any time during the study, compared to all patients (100%) in group B.

CONCLUSIONS

Administration of rHuEPO is an effective intervention for the management of chemotherapy-induced anaemia, significantly reducing RBC transfusion requirements in patients receiving platinum-based chemotherapy. Hb and Ht levels proved reliable indicators for response to rHuEPO treatment.