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Vinther A, Ramnarine E, Gastineau T, O'Brien L, Brehm O, Fryrear D. Approaches to Design an Efficient, Predictable Global Post-approval Change Management System that Facilitates Continual Improvement and Drug Product Availability. Ther Innov Regul Sci 2024; 58:433-442. [PMID: 38369639 PMCID: PMC11043098 DOI: 10.1007/s43441-024-00614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024]
Abstract
The complexity and inter-connectedness of operating in a global world for drug product supply has become an undeniable reality, further underscored by the COVID-19 pandemic. For Post-Approval Changes (PACs) that are an inevitable part of a product's commercial life, the impact of the growing global regulatory complexity and related drug shortages has brought the Global PAC Management System to an inflection point in particular for companies that have their products marketed in many countries.This paper illustrates through data analyzed for the first time from 145,000 + PACs for 156 countries, collected by 18 global pharma companies over a 3-year period (2019-2021), how severe the problem of global regulatory complexity is. Only PACs requiring national regulatory agency (NRA) approval prior to implementation were included in the data set. 1 of the 156 country NRAs approved all submitted PACs within a period of 6 months. The 6-month timeline was chosen because it is the recommended review timeline for major changes in the WHO guidance for vaccines and biotherapeutic products. 10 out of the 156 (6%) countries had no more than 10% of the PACs reviewed and approved in > 6 months. In 33 (22%) countries more than half of the PACs took > 6 months for approval. It is rare that the same PAC is approved globally within 6 months as individual NRAs take from a few months to years (in some cases > 5 years) for their review.The global PAC management complexity has steadily grown over the past 20 years. Attempts thus far to solve this problem have not made any meaningful difference. Senior leaders and decision-makers across the interdependent components of the complex Global PAC Management System (industry and regulators) must come together and collaboratively manage the problem holistically with the objective of ensuring global drug product availability instead of continuing with distinct stakeholder or country-focused solutions, which can tend to worsen the problem.In this paper, the Chief Quality Officers (CQOs) from 18 of the largest innovator pharma companies (see Acknowledgements) are speaking with One-Voice-of-Quality for PACs (1VQ for PACs Initiative). They are recommending a set of 8 approaches to activate a holistic transformation of the Global PAC Management System. This article presents their view on the problem of global regulatory complexity for managing PACs, it's impact on continual improvement and the risk to drug product supply, as well as approaches that can help alleviate the problem.
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Affiliation(s)
- Anders Vinther
- QBA - Quality Business Administration, San Carlos, CA, USA.
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Andereggen L, Gralla J, Christ E. The diagnostic yield of inferior petrosal sinus sampling in Cushing syndrome in the era of ovine CRH shortage. Acta Neurochir (Wien) 2024; 166:167. [PMID: 38565838 PMCID: PMC10987334 DOI: 10.1007/s00701-024-06058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE The ovine corticotropin-releasing hormone (oCRH) stimulation test has been routinely used in the diagnostic work-up of ACTH-dependent Cushing syndrome (CS). With oCRH currently being out-of-stock in Europe, we aimed at evaluating the diagnostic performance of inferior petrosal sinus sampling (IPSS) without oCRH stimulation. METHODS We compared the values of 40 patients with ACTH-dependent CS and negative MRI findings in whom ACTH was measured before and after oCRH stimulation. RESULTS The ratio of central-to-peripheral ACTH measurement (IPS:P) before the combined 3, 5, and 10 min of oCRH stimulation yielded diminished sensitivity (85% vs. 97%), alongside markedly decreased specificity (57% vs. 71%), as well as reduced positive and negative predictive values (90% vs. 94% and 44% vs. 83%), respectively. CONCLUSIONS With the current drug shortages in Europe, ACTH measurements without oCRH stimulation in IPSS cannot be recommended. Thus, we call for desmopressin or the commercially available human CRH as a potential alternative in the confirmation of ACTH excess by IPSS in equivocal MRI findings.
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Affiliation(s)
- Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
- Faculty of Medicine, University of Bern, Bern, Switzerland.
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Bern, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Emanuel Christ
- Department of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Schwartzberg E, Marom E, Vishkautzan A, Gorelik E, Shani S. Drug shortages in Israel, revisited: a bitter pill to swallow. Isr J Health Policy Res 2024; 13:14. [PMID: 38500149 PMCID: PMC10946123 DOI: 10.1186/s13584-024-00600-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In 2017, we published an article addressing drug shortages (DS) in Israel, exploring regulatory perspectives, challenges, and potential solutions. Since then, DS remain a significant concern for patients, healthcare providers, and policymakers globally. In this updated article, we revisit the topic, providing new insights, data, and analysis on the current DS landscape in Israel, efforts to mitigate them, and propose strategies to combat this escalating issue. METHODS We conducted a comprehensive search of the Israeli Ministry of Health (MOH) DS database, spanning from 2014 to the present. We extracted DS numbers and their reasons. Further searches on the Israeli MOH website, pharmaceutical division archives, and the internet yielded official MOH publications and correspondence regarding regulatory responses to DS from 2017 onwards. Additionally, two specific cases of DS were examined to analyze their handling. Recent activities and publications from the Israeli MOH aimed at reducing DS were also reviewed. RESULTS Between 2014 and 2022, DS surged 2.66-fold. Total DS were 3228; 672 due to commercial reasons, and 2556 to operational reasons (20.5% and 79.5% respectively). The average duration of intermittent DS increased 1.56-fold, from 85 to 133 days. Manufacturers informed the MOH 22 days prior to actual shortage on average. Analyzing 2022's DS (640) by ATC groups, prominent categories included nervous system drugs (18%), drugs acting on the alimentary tract and metabolism (14%), and dermatologicals (11%). Operational DS in 2022 (n = 564) were primarily due to stock delivery delays (38%), stock over-utilization (12%), and raw material shortages (9%). Sixteen official MOH publications on DS were identified from 2017 onwards. Moreover, two high-impact DS case studies were examined. CONCLUSION Despite routine monitoring by the Israeli MOH and updating the DS policy throughout this period, DS persist, intensifying annually and posing serious health risks. This trend mirrors international patterns, affecting countries globally. In Israel's uniquely structured healthcare system, with its swift stakeholder cooperation and implementation capabilities, more effective DS management is conceivable. We propose ten universally applicable rules to address DS challenges.
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Affiliation(s)
- Eyal Schwartzberg
- School of Pharmacy, Health Sciences Faculty, Ben Gurion University, Beer Sheva, Israel.
- Pharmaceutical Society of Israel, Tel Aviv, Israel.
| | - Eli Marom
- Pharmaceutical Division, Ministry of Health, Jerusalem, Israel
| | - Alla Vishkautzan
- Pharmacovigilance and Risk Management Department, Pharmaceutical Division, Ministry of Health, Jerusalem, Israel
| | - Einat Gorelik
- Pharmacovigilance and Risk Management Department, Pharmaceutical Division, Ministry of Health, Jerusalem, Israel
| | - Segev Shani
- Department of Health Management and Policy, Guilford Glazer Faculty of Business and Management and Health Sciences Faculty, Ben Gurion University, Beer Sheva, Israel
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Goncette V, Radermecker R. [ Drug shortages : a fatality ?]. Rev Med Liege 2024; 79:23-28. [PMID: 38223966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
In recent years, the number of drug shortages has risen alarmingly both in Belgium and internationally. Between 2010 and 2020, the number of reported shortages is almost 27 times higher, according to the French Agency for the Safety of Medicines and Health Products. A recent survey conducted by the European Association of Hospital Pharmacists showed that 95 % of hospital pharmacists consider drug shortages to be a major problem. The drug classes most affected include anti-infectives, analgesics and anaesthetics. The sudden and unpredictable occurrence of drug shortages has a negative impact on the daily lives of healthcare professionals and patients. Doctors are sometimes forced to prescribe alternative treatments that are considered less effective or even less well tolerated. These alternatives make it more difficult for patients to adhere to their treatment and generate an additional risk of medication errors. There are several possible solutions to minimize these shortages: relocating production sites to Europe, imposing penalties on offending companies, adopting a common European policy for managing shortages of medicines of major therapeutic interest,... As a corollary to these proposals, legal texts have been adopted to regulate and guarantee the supply of medicines in Belgium.
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Affiliation(s)
| | - Régis Radermecker
- Service de Diabétologie, Nutrition et Maladies métaboliques, CHU Liège, Belgique
- Département de Pharmacologie clinique, Centre Interdisciplinaire de Recherche sur le Médicament (CIRM), ULiège, Belgique
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Angelis A, Montibeller G, Kanavos P. A structured methodology for essential medicines lists and health emergency stockpiles: Experience with the Emergency Medicines Buffer Stock in the United Kingdom. Soc Sci Med 2023; 337:116236. [PMID: 37857240 DOI: 10.1016/j.socscimed.2023.116236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Formularies of essential medicines, such as Essential Medicines Lists (EMLs) and health emergency stockpiles, are intended to be always available, including in emergency situations, acting as important tools for access to medicines. The Emergency Medicines Buffer Stock (EMBS) in the United Kingdom (UK) was a stockpile of critical medicines managed by the UK Department of Health and Social Care (DHSC). We propose a new methodology for selecting and including medicines in EMLs and health emergency stockpiles and empirically apply it for selecting medicines in the case of the UK EMBS. METHODS We used Multi-Attribute Value Theory and Portfolio Decision Analysis to develop a three-phase methodological framework for medicines selection, involving: (i) the decision context definition and selection of evaluation criteria, (ii) the therapeutic area prioritisation, and (iii) the medicines value-for-money evaluation and product selection. The EMBS application took place in 2018-2019 and focused on therapeutic area prioritisation, involving primary data collection through expert interviews (n = 4), a workshop with DHSC decision-makers (n = 13), and an online survey with National Clinical Directors and relevant experts (n = 24). A Monte Carlo simulation supported therapeutic area prioritisation using the British National Formulary (BNF) classification. FINDINGS Two criteria sets were selected for i) therapeutic area prioritisation, reflecting the value concerns of population need and shortage severity, and ii) medicines evaluation, reflecting magnitude of clinical benefit and supply vulnerability, among others. Primary evidence was collected for "national need" and "shortage severity", based on which a "population health loss" index was developed. A total of 51 therapeutic areas were ranked using their index value while assessing the robustness of the ranking. The top ranked therapeutic area was antisecretory drugs and mucosal protectants, closely followed by diabetes drugs. CONCLUSIONS The methodological application generated a ranking of therapeutic areas based on expected "population health loss" index, while addressing evidence uncertainty. The methodology can be adapted for other EMLs and emergency stockpile contexts to inform medicines selection.
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Affiliation(s)
- A Angelis
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Policy and LSE Health - Medical Technology Research Group (MTRG), London School of Economics and Political Science, London, UK.
| | - G Montibeller
- Loughborough Business School, Loughborough University, Leicestershire, UK; Center for Risk and Economic Analysis of Threats and Emergencies (CREATE), University of Southern California, Los Angeles, CA, USA
| | - P Kanavos
- Department of Health Policy and LSE Health - Medical Technology Research Group (MTRG), London School of Economics and Political Science, London, UK
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Poulsen JH, Jensen SR, Clemmensen MH, Holck MV, Uldal N, Kart T, Nielsen GS, Armandi H, Hansen OLM. Evaluation of the establishment of a national task force - A systematic measure to manage critical drug shortages in hospitals. Explor Res Clin Soc Pharm 2023; 11:100322. [PMID: 37694165 PMCID: PMC10485142 DOI: 10.1016/j.rcsop.2023.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Drug shortages (DSs) have become a well-known challenge in health care, and serious patient safety consequences, such as medication errors and adverse patient outcomes are reported. To meet these challenges, a national task force was established to manage and minimize the impact of critical DSs' on hospitals in Denmark. Objective To evaluate the establishment of the National Task Force for Critical Drug Shortages (NTF) in terms of quality, patient safety, and resources from different actor perspectives related to critical DS management in Danish hospitals. Methods Five online focus group interviews were held with participants representing different actor perspectives, all of whom were involved in managing DSs. They represent actors from 1) the NTF; 2) hospital pharmacists not involved in the NTF but who manage DSs locally and/or regionally; 3) the procurement departments of hospital pharmacies; 4) pharmacy technicians performing clinical pharmacy services at a patient level, and 5) the procurement and supply unit at Amgros. Results The thematic analysis revealed four major themes: 1) centralized management of critical DSs is predominantly considered to be positive, 2) collaboration and professional discussion across actors and actor levels, 3) mixed attitudes toward the current communication platforms and format, and 4) short supply of time. Conclusion The NTF ensures a consistent and qualified management of critical DSs. The NTF ensures the evaluation of different patient safety aspects related to identification of a suitable alternative. Challenges with the communication platform and transparency of the process from the NTF toward hospital pharmacy were mentioned but overall, the NTF contributes to a successful use of resources in health care.
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Affiliation(s)
- Joo Hanne Poulsen
- Medicines Information Center, The Hospital Pharmacy, Capital Region of Denmark, Copenhagen, NV, Denmark
| | - Stine Raaby Jensen
- The Hospital Pharmacy, Capital Region of Denmark, Copenhagen, S, Denmark
| | - Marianne Hald Clemmensen
- Medicines Information Center, The Hospital Pharmacy, Capital Region of Denmark, Copenhagen, NV, Denmark
| | | | | | | | | | - Helle Armandi
- Medicines Information Center, The Hospital Pharmacy, Capital Region of Denmark, Copenhagen, NV, Denmark
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Routsolias JC, Webb AN. Drug Shortages Negatively Impact Health Systems and Bedside Patient Care. J Med Toxicol 2023:10.1007/s13181-023-00950-6. [PMID: 37266907 DOI: 10.1007/s13181-023-00950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Joanne C Routsolias
- Department of Emergency Medicine and Pharmacy, Cook County Health, 1950 West Polk Street, 7th Floor EM Admin, IL, 60612, Chicago, USA.
| | - Ashley N Webb
- Kentucky Poison Control Center of Norton Children's Hospital, Louisville, KY, USA
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Troger A, Burns MM. Pharmaceutical Purchasing: a Review of the Landscape and Implications for Antidotal Therapies. J Med Toxicol 2023:10.1007/s13181-023-00943-5. [PMID: 37249803 DOI: 10.1007/s13181-023-00943-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/15/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
The management of the poisoned patient often requires the utilization of uncommonly used pharmaceutical interventions. These interventions can be associated with significant costs to both the patient and treating institution. Pharmaceutical supply shortages and issues with accessibility of antidotal therapies complicate the management of many toxic exposures. These challenges are an inherent property of the pharmaceutical purchasing infrastructure in the United States, which is a complicated network of public and private intra-institutional agreements. The cost and availability of any given therapy is dependent on the individual contracting agreements between the treating institution, payer, pharmacy benefit manager, manufacturer or wholesaler, and in some cases a specialty pharmacy. Small or remote hospitals may experience greater challenges related to insufficient patient volume to achieve predicable prescribing patterns of rare and expensive medications, necessitating consignment purchasing arrangements. Although pharmaceutical costs are the focus of recent legislative attention, these reforms are not expected to significantly alter the cost or availability of antidotal therapies.
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Affiliation(s)
- Andrew Troger
- Harvard Medical Toxicology Fellowship, Boston, MA, USA.
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Emergency Medicine, Cambridge Health Alliance, Cambridge, MA, USA.
| | - Michele M Burns
- Harvard Medical Toxicology Fellowship, Boston, MA, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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Sabogal De La Pava ML, Tucker EL. Drug shortages in low- and middle-income countries: Colombia as a case study. J Pharm Policy Pract 2022; 15:42. [PMID: 35698240 PMCID: PMC9189796 DOI: 10.1186/s40545-022-00439-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Drug shortages are a global problem. Analyzing shortages worldwide is important to identify possible relationships between drug shortages across countries, determine strategies that reduce drug shortages, and reduce the inequality in access to medicines between countries. In contrast to well-documented shortages in high-income countries, there are few studies that consider low- and middle-income economies. We evaluate drug shortages in one middle-income country, Colombia. Methods We collected data from INVIMA, the institution responsible for managing medicine shortage alerts in Colombia. We classified the data using the Anatomical Therapeutic Chemical (ATC) classification system and analyzed them using descriptive statistics. We considered a study period from 2015 to 2021 (vital medicines) and from 2010 to 2020 (non-vital medicines). Results In total, 173 unique ATC codes were in shortage. These included antidotes, alimentary tract and metabolism products, anesthetics, cardiac stimulants and antithrombotic agents. The major causes were manufacturing problems and few suppliers. Drug shortages substantially increased from 2020 to May 2021 due to the COVID-19 pandemic. Among resolved shortages, the average duration was 1.6 years with a standard deviation of 1.9 years. The longest, naloxone tablets, were in shortage for almost 10 years. Conclusions Drug shortages are a persistent problem in Colombia. Government institutions have made progress in implementing systems and procedures to report them. However, the approaches implemented need to be maintained and refined. This study lays the groundwork for the analysis of drug shortages in other LMICs. We highlight the necessity of addressing drug shortages in their global context and reducing the inequality in access to medicines between countries.
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Affiliation(s)
| | - Emily L Tucker
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA.,School of Health Research, Clemson University, Clemson, SC, USA
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Khattar G, Hallit J, El Chamieh C, Bou Sanayeh E. Cardiovascular drug shortages in Lebanon: a broken heart. Health Econ Rev 2022; 12:24. [PMID: 35403980 PMCID: PMC8996493 DOI: 10.1186/s13561-022-00369-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/30/2022] [Indexed: 05/31/2023]
Abstract
For nearly 3 years now, Lebanon has been assailed by compounded crises. With the economic instability, the coronavirus pandemic, and the explosion of the Beirut Port on August 4, 2020; the fragile Lebanese healthcare system has found itself at massive risk of a catastrophic public health crisis secondary to cardiovascular drug shortages. The time has come for public health authorities to find urgent solutions for this national trajedy that is projected to last for years.
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Affiliation(s)
- Georges Khattar
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Notre Dame des Secours University Hospital, Jbeil, Lebanon
| | - Jennifer Hallit
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Carolla El Chamieh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Elie Bou Sanayeh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Kuruc Poje D, Kifer D, Huys I, Miranda J, Jenzer H, Miljković N, Hoppe-Tichy T, Bochniarz M, Frontini R, Schwartz DG, Vujić-Aleksić V, Nežić L, Rinaki E, Tzimis L, Green K, Jovanić J, Carić B, Mandić D, Vilić K, Bochenek T, Bačić Vrca V, Marušić S. Patients perspectives on drug shortages in six European hospital settings - a cross sectional study. BMC Health Serv Res 2021; 21:689. [PMID: 34253212 DOI: 10.1186/s12913-021-06721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p < 0.001) while the fewest patients were in H-SE (1 %, N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional. Conclusions Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06721-9.
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Mazer-Amirshahi M, Fox ER, Routsolias JC, Johnson-Arbor K, Mycyk MB. How Can We "Get the Lead Out" Without Chelators? J Med Toxicol 2021; 17:330-332. [PMID: 34031804 PMCID: PMC8143065 DOI: 10.1007/s13181-021-00848-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA. .,National Capital Poison Center, Washington, DC, USA.
| | - Erin R Fox
- Department of Pharmacy Services, University of Utah Health, Salt Lake City, UT, USA
| | - Joanne C Routsolias
- Department of Emergency Medicine, Division of Toxicology, Cook County Health, Chicago, IL, USA
| | - Kelly Johnson-Arbor
- National Capital Poison Center, Washington, DC, USA.,MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mark B Mycyk
- Department of Emergency Medicine, Division of Toxicology, Cook County Health, Chicago, IL, USA
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13
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Fox ER, Johnson-Arbor K, Mazer-Amirshahi M. Will There Ever be an Antidote for Drug Shortages? J Med Toxicol 2021; 17:321-322. [PMID: 33687652 DOI: 10.1007/s13181-021-00830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Erin R Fox
- Department of Pharmacy Services, University of Utah Health, Salt Lake City, UT, USA
| | - Kelly Johnson-Arbor
- National Capital Poison Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - Maryann Mazer-Amirshahi
- MedStar Georgetown University Hospital, Washington, DC, USA.
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
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14
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Cameron EE, Bushell MJA. Analysis of drug shortages across two countries during pre-pandemic and pandemic times. Res Social Adm Pharm 2020; 17:1570-1573. [PMID: 33323334 DOI: 10.1016/j.sapharm.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Drug shortages have a negative impact on individual health outcomes for patients and health care systems more broadly. In recent years, regulatory bodies, such as the Therapeutic Good Administration in Australia, have provided information about an increasing number of drug shortages. It is reported that 90% of medicines in Australia are imported; this leaves Australia vulnerable to international drug shortages. It has been suggested that Australia is heavily reliant on the US as its primary source of medicines. OBJECTIVE(S) To determine whether there are significant trends in the quantity, frequency, and nature of drug shortages between the US and Australia in a pre-pandemic and pandemic climate. METHODS This study mapped and analyzed drug shortages reported by both the United States Food and Drug Administration (FDA) and the Australian Therapeutic Goods Administration (TGA) in 2019 and 2020. RESULTS In 2019 (pre-COVID19), only 4% of US drug shortages were reported in Australia; this rose to 7% in 2020. Between 2019 and 2020, the number of US drug shortages increased by 37%, whilst the number of Australian drug shortages increased by 300%. CONCLUSIONS The Australian pharmaceuticals market is indeed more vulnerable to drug shortages, particularly in the event of a global pandemic such as COVID-19. However, these shortages are not significantly influenced by the US drug market.
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Affiliation(s)
- Eliza E Cameron
- Pharmacy Discipline, Faculty of Health, University of Canberra. Bruce, ACT, 2617, Australia.
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15
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Kruijtbosch M, Floor-Schreudering A, van Leeuwen E, Göttgens-Jansen W, Bouvy ML. Moral reasoning perspectives of community pharmacists in situations of drug shortages. Res Social Adm Pharm 2020:S1551-7411(20)31197-9. [PMID: 33349586 DOI: 10.1016/j.sapharm.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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16
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Zaidi STR, Hasan SS. Personal protective practices and pharmacy services delivery by community pharmacists during COVID-19 pandemic: Results from a national survey. Res Social Adm Pharm 2021; 17:1832-7. [PMID: 33317761 DOI: 10.1016/j.sapharm.2020.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 11/24/2022]
Abstract
Introduction Coronavirus disease (COVID19) has adversely affected the delivery of various health services. Little is known about the impact of COVID19 on pharmacy services across the United Kingdom (UK). We surveyed community pharmacists across the UK to understand their protective practices, professional and general well-being, and the delivery of pharmacy services during the COVID19 pandemic. Methods Community pharmacists were invited to participate in a cross-sectional survey via the nationwide weekly newsletter of Pharmaceutical Services Negotiating Committee and the local pharmaceutical committees during the second week of May 2020. The survey remained open for 4 weeks. Results A total of 206 pharmacists responded to the survey with representations from England, Northern Ireland, Scotland, and Wales. The majority of pharmacists (>75% or above) reported an increase in customer traffic to their pharmacy and were asking relevant questions from patients with flu-like symptoms before signposting them to the appropriate care. Most pharmacists (>85%) were maintaining a safe distance of 2 m from customers and 72% were wearing an N95 protective mask and 28% were using protective gloves and apron in addition to safe distancing and protective masks. Ninety-nine percent of pharmacists reported drug shortages with 38% and 26% reported significant drug shortages and critical drug shortages causing disruptions beyond over the counter medicines. Eighty-nine percent pharmacists reported inappropriate behaviour from patients or carers with 31% and 16% reported it to be a regular or frequent problem, respectively. Fifty-three% of pharmacists were willing to offer their assistance for mass testing of COVID19 antibodies if adequate training and reimbursement are provided. Conclusion Community pharmacists in the UK are facing considerable challenges in terms of personal protection and the delivery of pharmacy services. Inappropriate behaviour from patients and carers towards community pharmacists require urgent attention to ensure a safe working place for all community pharmacists. Coronavirus Disease 2019 (COVID19) has resulted in critical drug shortages in the United Kingdom. Community pharmacists are enforcing careful precautionary measures to prevent COVID19 transmission. Inappropriate consumer behaviour is reported by community pharmacists. Future planning of COVID19 should seek inputs to establish needs of community pharmacists.
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Mazer-Amirshahi M, Fox ER, Farmer BM, Stolbach AI. ACMT Position Statement: Medication Shortages During Coronavirus Disease Pandemic. J Med Toxicol 2020; 16:346-348. [PMID: 32418120 PMCID: PMC7229882 DOI: 10.1007/s13181-020-00782-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, USA
| | - Erin R Fox
- Drug Information and Support Services, University of Utah Health, Salt Lake City, UT, USA
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
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18
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Mazer-Amirshahi M, Fox ER, Nelson LS, Smith SW, Stolbach AI. ACMT Position Statement on Prescription Drug Shortages. J Med Toxicol 2020; 16:349-351. [PMID: 32297150 PMCID: PMC7320088 DOI: 10.1007/s13181-020-00775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Erin R Fox
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | | | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, NY, USA
- Institute for Innovations in Medical Education, NYU Langone Health, New York, NY, USA
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19
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Abstract
Purpose of review The COVID-19 outbreak has resulted in uncertainty for patients with autoimmune rheumatic diseases for several reasons. They are concerned about their risk of developing COVID-19 as many are immune suppressed from their disease and/or treatment, whether they should stop their advanced therapies, if they will have a worse outcome if/when infected due to their underlying medication condition(s) and if they will have drug availability, especially with press (without much data) coverage suggesting hydroxychloroquine may be used in COVID-19 infection causing diversion of medication supply. This article discusses how the pandemic affects people with systemic autoimmune rheumatic diseases. Recent findings Preliminarily, articles seem to suggest that patients with rheumatic diseases may not have more infections from SARS-CoV-2 and similar outcomes to age and gender matched patients, but fear of rheumatic medications increasing their risk, drug shortages, and work exposure all are concerns for patients. Recent findings The long term effects of the pandemic in patients with rheumatic diseases will not be known until much later and likely include stressors flaring disease (fear, illness, job loss, social isolation), post-traumatic stress, flaring due to stopping medications, less physician visits with subsequent under-treatment, and increases in chronic concomitant fatigue, pain, fibromyalgia.
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20
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Zaprutko T, Kopciuch D, Bronisz M, Michalak M, Kus K, Nowakowska E. Drug shortages as a result of parallel export in Poland - Pharmacists' opinions. Health Policy 2020; 124:563-567. [PMID: 32199618 DOI: 10.1016/j.healthpol.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Drug shortages are recognized as a global problem. However, studies concerning drug shortages in Europe are scarce. Therefore, the main aim of the study was to conduct an analysis concerning drug shortages in Polish pharmacies and to collect pharmacists' opinions about parallel trade and 'reverse traffic' of medicines. METHODS The study was conducted between October 2015 and July 2016 using a specially designed anonymous questionnaire consisting of 10 questions. The tool was delivered to pharmacists. From over 1800 distributed sheets, 435 were included. RESULTS According to Polish pharmacists' opinions, shortages are most frequently associated with anticoagulants and antidiabetics and are an increasing problem in Poland. In respondents' opinion, fines for 'reverse traffic' should be high and restrictive and manufacturers should be obliged to build stocks for a certain period. CONCLUSIONS Drug shortages concern several groups of medicines, often without generics. Solutions incorporated in Poland and aimed to reduce shortages seem to be ineffective. Reduction of drug shortages should be a priority of all stakeholders, because it is not only a Polish problem, but it is a common European issue.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland.
| | - Dorota Kopciuch
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
| | - Maria Bronisz
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
| | - Michał Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
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21
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Shi Y, Yang P, Li X, Lv J, Yin T, Gong Z, Sun S, Zhou B. Combating drug shortages in China: surveillance warning and practice standardization. Int J Clin Pharm 2020; 42:309-314. [PMID: 32048122 DOI: 10.1007/s11096-020-00987-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/31/2020] [Indexed: 11/25/2022]
Abstract
Like other countries, China has been experiencing drug shortages during the past years, including drugs on the National Essential Medicine List and emergency drugs. Drug shortages have raised public concerns in China and have severe impacts on all stakeholders in the supply chain, especially patients and hospitals. Recently, Chinese governments have ramped up several measures to ensure a steady supply of essential and first-aid drugs. In this commentary, we share our experiences of addressing drug shortages at Hunan Province, central China. We focus on the establishment of a provincial drug shortage monitoring center, and the Center's efforts to standardize practices on the management of drug shortages and identify therapeutic alternatives for drugs in short supply based on international best practices.
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Affiliation(s)
- Yin Shi
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Drug Shortage Surveillance and Early Warning Center, Changsha, 410008, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China
| | - Ping Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Drug Shortage Surveillance and Early Warning Center, Changsha, 410008, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China
| | - Xiangping Li
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Drug Shortage Surveillance and Early Warning Center, Changsha, 410008, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China
| | - Jinfeng Lv
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Drug Shortage Surveillance and Early Warning Center, Changsha, 410008, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China
| | - Tao Yin
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Drug Shortage Surveillance and Early Warning Center, Changsha, 410008, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Drug Shortage Surveillance and Early Warning Center, Changsha, 410008, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China
| | - Shusen Sun
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Hunan Drug Shortage Surveillance and Early Warning Center, Changsha, 410008, Hunan, China. .,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China. .,Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, 01119, USA.
| | - Boting Zhou
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Hunan Drug Shortage Surveillance and Early Warning Center, Changsha, 410008, Hunan, China. .,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China.
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22
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Clark SL, Levasseur-Franklin K, Pajoumand M, Barra M, Armahizer M, Patel DV, Wyatt Chester K, Tully AP. Collaborative Management Strategies for Drug Shortages in Neurocritical Care. Neurocrit Care 2020; 32:226-237. [PMID: 31077080 PMCID: PMC7222107 DOI: 10.1007/s12028-019-00730-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Drug shortages have become all too familiar in the health care environment, with over 200 drugs currently on shortage. In the wake of Hurricane Maria in September 2017, hospitals across the USA had to quickly and creatively adjust medication preparation and administration techniques in light of decreased availability of intravenous (IV) bags used for compounding a vast amount of medications. Amino acid preparations, essential for compounding parenteral nutrition, were also directly impacted by the hurricane. Upon realization of the impending drug shortages, hospitals resorted to alternative methods of drug administration, such as IV push routes, formulary substitutions, or alternative drug therapies in hopes of preserving the small supply of IV bags available and prioritizing them for them most critical needs. In some cases, alternative drug therapies were required, which increased the risk of medication errors due to the use of less-familiar treatment options. Clinical pharmacists rounding with medical teams provided essential, patient-specific drug regimen alternatives to help preserve a dwindling supply while ensuring use in the most critical cases. Drug shortages also frequently occur in the setting of manufacturing delays or discontinuation and drug recalls, with potential to negatively impact patient care. The seriousness of the drug shortage crisis reached public attention by December 2017, when political and pharmacy organizations called for response to the national drug shortage crisis. In this article, we review institutional mitigation strategies in response to drug shortages and discuss downstream effects of these shortages, focusing on medications commonly prescribed in neurocritical care patients.
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Affiliation(s)
- Sarah L Clark
- Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Mehrnaz Pajoumand
- Department of Pharmacy, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Megan Barra
- Department of Pharmacy, Massachusetts General Hospital, 55 Fruit Street GRB-005, Boston, MA, 02114, USA
| | - Michael Armahizer
- Department of Pharmacy, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Deepa V Patel
- Department of Pharmacy, Wellstar Kennestone Hospital, 677 Church Street, Marietta, GA, 30060, USA
| | - Katleen Wyatt Chester
- Department of Pharmacy and Clinical Nutrition, Emory University School of Nursing, Grady Memorial Hospital, 80 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
| | - Andrea P Tully
- Department of Pharmacy, Christiana Care Health System, 4755 Ogletown-Stanton Rd, Newark, DE, 19718, USA
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23
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Duong MH, Moles RJ, Chaar B, Chen TF. Stakeholder perspectives on the challenges surrounding management and supply of essential medicines. Int J Clin Pharm 2019; 41:1210-1219. [PMID: 31444686 DOI: 10.1007/s11096-019-00889-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 08/01/2019] [Indexed: 11/25/2022]
Abstract
Background Shortages of essential medicines impact patient safety and raise the costs of medicines to consumers and governments. Ongoing medicine shortages have become a critical issue that threaten global access to medicines. Objective The aim of this study was to explore key stakeholders' perspectives on the challenges surrounding management and supply of essential medicines. Setting Western Pacific, Asia, Europe, North America, and Africa. Methods In-depth, semi-structured interviews with 47 participants were conducted across seven stakeholder groups globally. Stakeholders included government, academics, consumer groups, non-profit organisations, hospital healthcare providers, manufacturers, and wholesaler/distributors. A grounded theory approach was applied to qualitative analysis. Main outcome measure Stakeholders' perspectives on the challenges surrounding management and supply of essential medicines. Results This study showed that supporting consumer demand for a wide range of therapeutic products required increased resources and coordination. Four main themes were identified: (1) consumer demand for a wide range of individual therapeutic needs cannot be sustained by the supply chain; (2) there lacked a coordinated approach to manage medicine shortages throughout the supply chain; (3) there were gaps in communication throughout the continuum of the supply chain; and (4) both international and local disruptions contributed to vulnerabilities in the supply chain. Conclusion Prioritisation of supply, logistics, and budget decisions around essential medicines need to be clearly coordinated between stakeholders to mitigate medicine shortages. Financial structures should include resilience planning to support fair and equitable access to medicines that meet consumer needs.
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Affiliation(s)
- Mai H Duong
- School of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia.
- World Hospital Pharmacy Research Consortium (WHoPReC), Sydney, Australia.
- School of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia.
| | - Rebekah J Moles
- School of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia
- World Hospital Pharmacy Research Consortium (WHoPReC), Sydney, Australia
| | - Betty Chaar
- School of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia
- World Hospital Pharmacy Research Consortium (WHoPReC), Sydney, Australia
| | - Timothy F Chen
- School of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia
- World Hospital Pharmacy Research Consortium (WHoPReC), Sydney, Australia
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24
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Videau M, Lebel D, Bussières JF. Drug shortages in Canada: Data for 2016-2017 and perspectives on the problem. Ann Pharm Fr 2019; 77:205-211. [PMID: 30670298 DOI: 10.1016/j.pharma.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/17/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Many signs point to the growing importance of drug shortages in Canada and around the world. Although drug shortages affect clinicians and patients every day, there is a paucity of literature describing the specific problems experienced and their clinical consequences. To describe the drug shortage situation in Canada in 2016-2017 and to discuss this issue in the Canadian context. METHODS This retrospective study was based on data from one Canadian wholesaler (McKesson Canada) and the official Drug Shortages Canada website. RESULTS From August 31, 2016, to September 4, 2017, the McKesson database showed 583 drug shortages, averaging 160 (standard deviation [SD] 180) days, and the drug shortage website showed 2,129 shortages, averaging 118 (SD 113) days. Of these shortages, 26% in the McKesson database and 14% at the official drug shortage website were for parenteral products. In both the McKesson database and the Canadian drug shortage database, the leading drug classes with shortages were central nervous system drugs (26.4% and 31.8%, respectively), cardiovascular drugs (12.0% and 21.9%), anti-infective agents (11.2% and 8.5%), gastrointestinal drugs (7.9% and 6.2%) and antineoplastic agents (7.4% and 5.1%). CONCLUSIONS This descriptive study highlights the high number of shortages in Canada in 2016-2017. The new federal regulation requiring declaration of drug shortages should lead to better monitoring of this problem at the national level. Although the causes of shortages are often identified, manufacturers and regulators are frequently unable to address or effectively prevent drug shortages.
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Affiliation(s)
- M Videau
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T1C5 Montréal, QC, Canada
| | - D Lebel
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T1C5 Montréal, QC, Canada
| | - J-F Bussières
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T1C5 Montréal, QC, Canada.
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25
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Said A, Goebel R, Ganso M, Zagermann-Muncke P, Schulz M. Drug shortages may compromise patient safety: Results of a survey of the reference pharmacies of the Drug Commission of German Pharmacists. Health Policy 2018; 122:1302-1309. [PMID: 30337159 DOI: 10.1016/j.healthpol.2018.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/19/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
Drug shortages are a complex problem and of growing concern. To evaluate implications of drug shortages in terms of outpatient and inpatient safety, the Drug Commission of German Pharmacists surveyed its two nationwide reference pharmacy networks: 865 community and 54 hospital pharmacies. Participants were asked to complete a six-question online survey, covering relevance and challenges of drug shortages in everyday practice as well as consequences for patient safety. Answers were given in the context of the last three months prior to the survey. In total, 482 community (55.7%) and 36 hospital pharmacies (66.7%) participated. Occurrence of drug shortages were confirmed by 88.6% of community and 80.6% of hospital pharmacies. Thus, for example, a substitute was dispensed more than 15 times (60.7% of community, 44.8% of hospital pharmacies) during the 3-month-period. Comparing community and hospital pharmacies, differences in the incidence or severity of consequences for patient safety were apparent. Community pharmacies mainly confirmed adverse effects on patients' medication adherence (60.4%) and treatment discontinuation (25.8%). A delay or deny of a life-saving treatment (39.4%) was largely reported by hospital pharmacies. Medication errors were reported by 20.1% of the community and 21.2% of the hospital pharmacies, respectively. Taken together, sustainable solutions are needed to counteract drug shortages and to ensure adequate treatment for patients.
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Affiliation(s)
- André Said
- Drug Commission of German Pharmacists (AMK), Unter den Linden 19-23, 10117 Berlin, Germany.
| | - Ralf Goebel
- Drug Commission of German Pharmacists (AMK), Unter den Linden 19-23, 10117 Berlin, Germany.
| | - Matthias Ganso
- Drug Commission of German Pharmacists (AMK), Unter den Linden 19-23, 10117 Berlin, Germany.
| | - Petra Zagermann-Muncke
- Drug Commission of German Pharmacists (AMK), Unter den Linden 19-23, 10117 Berlin, Germany; ABDATA Pharma-Daten-Service, Avoxa - Mediengruppe Deutscher Apotheker GmbH, Apothekerhaus Eschborn, Carl-Mannich-Straße 26, 65760 Eschborn, Germany.
| | - Martin Schulz
- Drug Commission of German Pharmacists (AMK), Unter den Linden 19-23, 10117 Berlin, Germany.
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Neff MP, Wagner D, Phillips BJ, Shanks A, Thompson A, Wilkins K, Naughton N, Voepel-Lewis T. Propofol Drug Shortage Associated With Worse Postoperative Nausea and Vomiting Outcomes Despite a Mitigation Strategy. AANA J 2018; 86:147-154. [PMID: 31573486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Drug shortages negatively affect patient care and outcomes. Postoperative nausea and vomiting (PONV) can be mitigated using risk assessment and prophylaxis. A 2012 propofol shortage provided an opportunity to study the impact of using prophylactic antiemetics and changing the technique from a propofol infusion to inhaled agents in an ambulatory surgery setting. We retrospectively collected data for 2,090 patients regarding PONV risk factors, anesthetic management, and PONV outcomes for periods before, during, and after the shortage. Patients during the propofol shortage experienced a higher incidence of PONV (11% vs 5% before the shortage), greater need for rescue antiemetics (3% vs 1%), and longer duration of stay (mean [SD] = 124 [115] minutes vs 118 [108] minutes). More patients in this group reported PONV at home (14% vs 7%), and 2 required unplanned admission or return to the hospital. During the shortage, patients had a 2-fold increase in the odds of PONV when adjusted for all risk factors. Antiemetics moderated the association between gender and PONV but did not change the effect of the shortage. Findings suggest that despite mitigation efforts, the inability to use propofol infusion was associated with worse PONV outcomes.
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Affiliation(s)
- Mary P Neff
- is the senior nurse anesthetist of the East Ann Arbor Surgery Center, which is affiliated with the University of Michigan Health System, Ann Arbor, Michigan
| | - Deborah Wagner
- is a clinical professor in the University of Michigan College of Pharmacy and the Department of Anesthesiology in the University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Brad J Phillips
- is an assistant chief nurse anesthetist in the Department of Anesthesiology, University of Michigan Health System
| | - Amy Shanks
- is an associate research scientist in the University of Michigan Department of Anesthesiology
| | - Aleda Thompson
- is a research analyst for the University of Michigan Department of Anesthesiology
| | - Karen Wilkins
- is the assistant medical director of the East Ann Arbor Surgery Center and assistant professor in the University of Michigan Department of Anesthesiology
| | - Norah Naughton
- is associate chair for education and program director, Department of Anesthesiology, University of Michigan
| | - Terri Voepel-Lewis
- is an associate research scientist for the University of Michigan Department of Anesthesiology
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Claus B, Bauters T, Laureys G. Drug shortages in a pediatric stem cell transplantation ward: Challenges and implications. A 5-year bilan. J Oncol Pharm Pract 2018; 25:841-846. [PMID: 29592767 DOI: 10.1177/1078155218765627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes the implications of shortages of pharmaceutical products used in conditioning and supportive care regimens of pediatric patients undergoing a hematopoietic stem cell transplantation in a tertiary care hospital. Between July 2011 and July 2016, a total of 84 individual shortages, affecting 22 different drugs (79.8% supportive care drugs; 20.2% chemotherapeutics) were detected with a mean duration of 85 days (SD 138) per individual drug shortage. Eighteen shortages were critical and very urgent. Sulfamethoxazol/trimethoprim, piperacillin/tazobactam, ranitidine, benzylpenicillin, ondansetron (supportive care) and methotrexate, melphalan (chemotherapeutics) had the longest supply disruptions. A variety of solutions could be identified including the purchase of a generic alternative (36.9%) for both oral and parenteral treatments (in a ratio 3:2). Urgent import from another (European) country was performed in 14 cases (16.7%). High impact solutions such as cohorting of patients and change of ongoing treatments (2.4%) were used for parenteral treatments only. Pharmaceutical modification was sometimes applied for oral treatments (2.4%). Due to persistent occurrence of these shortages, an efficient pharmacy workflow (electronic follow-up by end of 2016) and a multidisciplinary approach were needed.
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Affiliation(s)
- B Claus
- 1 Pharmacy Department, Ghent University Hospital, Ghent, Belgium.,2 Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - T Bauters
- 1 Pharmacy Department, Ghent University Hospital, Ghent, Belgium.,3 Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - G Laureys
- 3 Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
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Abstract
PURPOSE We describe trends in U.S. shortages impacting critical care drugs from 2001 to 2016. MATERIALS AND METHODS Shortages within the scope of critical care were identified using data from the University of Utah Drug Information Services. Shortage characteristics were described using standard descriptive statistics and regression analysis. RESULTS Of 1969 shortages reported, 1004 (51%) were for drugs used in critical care. New shortages fell from 2001 to 2004, then increased, peaking in 2011 (116). For critical care shortages, 247 (24.6%) involved drugs used for high acuity conditions. The majority of drugs on shortage were parenteral, (720; 71.7%) and 393 (39.1%) were single source drugs. Alternatives were available for 887 (88.3%) drugs, although 250 (24.9%) alternatives were impacted by shortages. Infectious disease drugs were the most common drugs on shortage, with 200 (19.9%) shortages, with a median duration of 7.7months (IQR=2.8-17.3). By the end of the study, 896 (89.2%) shortages were resolved and 108 (10.8%) remained active. The median duration for active shortages was 13.6months (IQR=5.8-58.4) while the duration for resolved shortages was 7.2months (IQR=2.8-17.3). CONCLUSIONS Although the number of new shortages peaked in 2011 and is now declining, there remain a substantial number of active shortages impacting critical care drugs.
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Affiliation(s)
- Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, United States; Georgetown University School of Medicine, 3900 Reservoir Road, Washington, DC 20007, United States.
| | - Munish Goyal
- Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, United States; Georgetown University School of Medicine, 3900 Reservoir Road, Washington, DC 20007, United States
| | - Suleman A Umar
- Department of Internal Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, United States
| | - Erin R Fox
- Department of Pharmacy and Drug Information Services, University of Utah, 50 N. Medical Drive A050, Salt Lake City, UT 84132, United States.
| | - Mark Zocchi
- Center for Healthcare Innovation and Policy Research, the George Washington University, 2300 Eye Street NW, Washington, DC 2007, United States.
| | - Kristy L Hawley
- Department of Surgery, MedStar Union Memorial Hospital, 201 E. University Parkway, Baltimore, MD 21218, United States
| | - Jesse M Pines
- Center for Healthcare Innovation and Policy Research, the George Washington University, 2300 Eye Street NW, Washington, DC 2007, United States; Department of Emergency Medicine, the George Washington University, 900 23rd Street NW, Washington, DC 20007, United States
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Bocquet F, Degrassat-Théas A, Peigné J, Paubel P. The new regulatory tools of the 2016 Health Law to fight drug shortages in France. Health Policy 2017; 121:471-476. [PMID: 28366432 DOI: 10.1016/j.healthpol.2017.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/06/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022]
Abstract
Drug shortages are becoming worrying for public health in the European Union. The French public authorities first took action against the causes of drug shortages in 2011 with a law, followed by a decree in 2012 to overcome the dysfunctions of the pharmaceutical distribution channel. These texts would establish emergency call centres implemented by pharmaceutical companies for pharmacists and for wholesalers to inform of shortages, and would oblige pharmaceutical companies to inform health authorities of any risk of potential shortage situation; they would also reinforce the declaration regime of the territory served by wholesalers. Through the Health Law of January 2016, France acquired new regulatory tools in order to fight against these shortages and wanted to target the drugs for which they are the most detrimental: the major therapeutic interest (MTI) drugs. Furthermore, this new text reinforces the legal obligations of pharmaceutical companies and of wholesalers for drug shortages and sets out the enforcement of sanctions in case of breach of these obligations. France's goal is ambitious: to implement coercive measures aiming at making the actors of the drug distribution channel aware of their responsibilities in order to take up the public health challenge triggered by drug shortages.
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Affiliation(s)
- François Bocquet
- Law and Health Economics Department, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France
; Health Law Institute (INSERM UMR S1145), Paris Descartes University, Sorbonne Paris Cité, 45 rue des Saints-Pères, 75006 Paris, France; Pharmacy Department, General Agency of Equipments and Health Products (AGEPS), 7 rue du Fer à Moulin, 75005 Paris, France.
| | - Albane Degrassat-Théas
- Law and Health Economics Department, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France
; Health Law Institute (INSERM UMR S1145), Paris Descartes University, Sorbonne Paris Cité, 45 rue des Saints-Pères, 75006 Paris, France; Pharmacy Department, General Agency of Equipments and Health Products (AGEPS), 7 rue du Fer à Moulin, 75005 Paris, France
| | - Jérôme Peigné
- Law and Health Economics Department, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France
; Health Law Institute (INSERM UMR S1145), Paris Descartes University, Sorbonne Paris Cité, 45 rue des Saints-Pères, 75006 Paris, France
| | - Pascal Paubel
- Law and Health Economics Department, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France
; Health Law Institute (INSERM UMR S1145), Paris Descartes University, Sorbonne Paris Cité, 45 rue des Saints-Pères, 75006 Paris, France; Pharmacy Department, General Agency of Equipments and Health Products (AGEPS), 7 rue du Fer à Moulin, 75005 Paris, France
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Gabrielli A, Layon NT, Bones HL, Layon AJ. The Tragedy of the Commons - Drug Shortages and Our Patients' Health. Am J Med 2016; 129:1237-1238. [PMID: 28029357 DOI: 10.1016/j.amjmed.2016.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Andrea Gabrielli
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Holly L Bones
- Pharmacy Procurement & Formulary Services, Department of Pharmacy and Therapeutics, The Geisinger Health System, Danville, Pa
| | - A Joseph Layon
- Critical Care Medicine, The Geisinger Health System, Danville, Pa; Department of Medicine, Temple University School of Medicine, Philadelphia, Pa.
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Abstract
The development of new therapies has a rich history, evolves quickly with societal trends, and will have an exciting future. The last century has seen an exponential increase in complex interactions between medical practitioners, pharmaceutical companies, governments and patients. We believe technology and societal expectations will open up the opportunity for more individuals to participate as information becomes more freely available and inequality less acceptable. Corporations must recognize that usual market forces do not function ideally in a setting where health is regarded as a human right, and as modern consumers, patients will increasingly take control of their own data, wellbeing, and even the means of production for developing their own treatments. Ethics and legislation will increasingly impact the processes that facilitate drug development, distribution and administration. This article collection is a cross-journal collaboration, between the Journal of Pharmaceutical Policy and Practice (JoPPP) and BMC Medicine that seeks to cover recent advances in drug development, medicines use, policy and access with high clinical and public health relevance in the future.The Medicine and the Future of Health article collection is a joint collection between BMC Medicine and Journal of Pharmaceutical Policy and Practice. Therefore, this Editorial by the guest editors has been published in both journals.
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Affiliation(s)
- Dale Fisher
- Infectious Disease Division, Department of Medicine, National University Hospital; National University Health Systems, 1E Kent Ridge Rd, Singapore, 119228, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | | | - Zaheer-Ud-Din Babar
- School of Pharmacy, University of Auckland, Auckland, New Zealand
- Lahore Pharmacy College, Lahore, Pakistan
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Fisher D, Wicks P, Babar ZUD. Medicine and the future of health: reflecting on the past to forge ahead. J Pharm Policy Pract 2016; 9:33. [PMID: 27800165 PMCID: PMC5078971 DOI: 10.1186/s40545-016-0086-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 01/24/2023] Open
Abstract
The development of new therapies has a rich history, evolves quickly with societal trends, and will have an exciting future. The last century has seen an exponential increase in complex interactions between medical practitioners, pharmaceutical companies, governments and patients. We believe technology and societal expectations will open up the opportunity for more individuals to participate as information becomes more freely available and inequality less acceptable. Corporations must recognize that usual market forces do not function ideally in a setting where health is regarded as a human right, and as modern consumers, patients will increasingly take control of their own data, wellbeing, and even the means of production for developing their own treatments. Ethics and legislation will increasingly impact the processes that facilitate drug development, distribution and administration. This article collection is a cross-journal collaboration, between the Journal of Pharmaceutical Policy and Practice (JoPPP) and BMC Medicine that seeks to cover recent advances in drug development, medicines use, policy and access with high clinical and public health relevance in the future. The Medicine and the Future of Health article collection is a joint collection between BMC Medicine and Journal of Pharmaceutical Policy and Practice. Therefore, this Editorial by the guest editors has been published in both journals.
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Affiliation(s)
- Dale Fisher
- Infectious Disease Division, Department of Medicine, National University Hospital; National University Health Systems, 1E Kent Ridge Rd, Singapore, 119228 Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Zaheer-Ud-Din Babar
- School of Pharmacy, University of Auckland, Auckland, New Zealand
- Lahore Pharmacy College, Lahore, Pakistan
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Malone C, Acheson JR, Hinds JD, McComiskey MH. Uterotonics for Non-emergent Caesarean Section: Protocol Change During UK-Licensed Drug Shortage. Ulster Med J 2016; 85:174-177. [PMID: 27698519 PMCID: PMC5031104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The aim was to assess the efficacy of Syntometrine ® (500 micrograms ergometrine with 5 units oxytocin) as an appropriate alternative first-line uterotonic for use in elective caesarean section (CS) during a national shortage of UK-licensed IV oxytocin from April-June 2014. An observational study was performed involving 2 groups of 22 women undergoing elective CS in a UK DGH during this period. Primary endpoints included mean estimated blood loss (EBL), haemoglobin drop post-operatively and transfusion requirement. Secondary endpoints were use of antiemetics and mean post-operative nausea and vomiting (PONV) score. Results for Syntometrine ® groups and syntocinon groups respectively: mean EBL (ml) 527.3 vs. 550.0 (p=0.5820), mean haemoglobin drop (g/dL) 0.977 vs. 0.982 (p=0.98), blood transfusion 1/22 vs. 0/22 (p=1). Intra-operative antiemetics 20/22 vs. 6/22 (p=<0.001), post-operative antiemetics 2/22 vs. 2/22 (p=1), mean PONV score 11.5 vs. 3.5 (p=0.099). As no significant difference in primary endpoints or PONV scores was observed between regimes, we conclude Syntometrine ® was a safe first-line haemostatic agent for elective CS during oxytocin shortage.
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Affiliation(s)
- C Malone
- Department of Obstetrics and Gynaecology, Craigavon Area Hospital, Southern Health and Social Care Trust, Northern Ireland
| | - JR Acheson
- Department of Obstetrics and Gynaecology, Daisy Hill Hospital, Southern Health and Social Care Trust, Northern Ireland
| | - JD Hinds
- Department of Anaesthetics, Craigavon Area Hospital, Southern Health and Social Care Trust, Northern Ireland
| | - MH McComiskey
- Department of Obstetrics and Gynaecology, Craigavon Area Hospital, Southern Health and Social Care Trust, Northern Ireland
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Bauters T, Claus BO, Norga K, Huys I, Simoens S, Laureys G. Chemotherapy drug shortages in paediatric oncology: A 14-year single-centre experience in Belgium. J Oncol Pharm Pract 2015; 22:766-770. [PMID: 26447099 DOI: 10.1177/1078155215610915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shortages of chemotherapy are a growing challenge for the healthcare system. We present the burden of drug shortages of chemotherapeutics in the paediatric hemato-oncology unit of a tertiary care hospital and solutions that were used to manage them. Between January 2001 and December 2014, 54 individual shortages were detected, affecting a total number of 21 different drugs. In total, 4127 shortage days were registered with a mean duration of 196.5 SD ± 144.0 days per individual drug shortage. Methotrexate, doxorubicin and carboplatin had the longest supply disruptions. Solutions to address the problems were purchase of a generic alternative, a change of individual treatment plans, cohorting of patients and import from abroad.
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Affiliation(s)
- Tiene Bauters
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Barbara Om Claus
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Koen Norga
- Pediatric Hematology/Oncology Unit, Queen Mathilde Mother and Child Center, Antwerp University Hospital, Edegem, Belgium Faculty of Medicine and Health Sciences, Antwerp University, Edegem, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Geneviève Laureys
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
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Abstract
CONTEXT Drug shortages have significantly increased over the past decade. There are limited data describing how shortages impact medical toxicology of drugs. OBJECTIVE To characterize drug shortages affecting the management of poisoned patients. MATERIALS AND METHODS Drug shortage data from January 2001 to December 2013 were obtained from the University of Utah Drug Information Service. Shortage data for agents used to treat poisonings were analyzed. Information on drug type, formulation, reason for shortage, shortage duration, marketing, and whether the drug was available from a single source was collected. The availability of a substitute therapy and whether substitutes were in shortage during the study period were also investigated. RESULTS Of 1,751 shortages, 141 (8.1%) impacted drugs used to treat poisoned patients, and as of December 2013, 21 (14.9%) remained unresolved. New toxicology shortages increased steadily from the mid-2000s, reaching a high of 26 in 2011. Median shortage duration was 164 days (interquartile range: 76-434). Generic drugs were involved in 85.1% of shortages and 41.1% were single-source products. Parenteral formulations were often involved in shortages (89.4%). The most common medications in shortage were sedative/hypnotics (15.6%). An alternative agent was available for 121 (85.8%) drugs; however, 88 (72.7%) alternatives were also affected by shortages at some point during the study period. When present, the most common reasons reported were manufacturing delays (22.0%) and supply/demand issues (17.0%). Shortage reason was not reported for 48.2% of drugs. DISCUSSION Toxicology drug shortages are becoming increasingly prevalent, which can result in both suboptimal treatment and medication errors from using less familiar alternatives. CONCLUSION Drug shortages affected a substantial number of critical agents used in the management of poisoned patients. Shortages were often of long duration and for drugs without alternatives. Providers caring for poisoned patients should be aware of current shortages and implement mitigation strategies to safeguard patient care.
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De Weerdt E, Simoens S, Hombroeckx L, Casteels M, Huys I. Causes of drug shortages in the legal pharmaceutical framework. Regul Toxicol Pharmacol 2015; 71:251-8. [PMID: 25591547 DOI: 10.1016/j.yrtph.2015.01.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Different causes of drug shortages can be linked to the pharmaceutical legal framework, such as: parallel trade, quality requirements, economic decisions to suspend or cease production, etc. However until now no in-depth study of the different regulations affecting drug shortages is available. The aim of this paper is to provide an analysis of relevant legal and regulatory measures in the European pharmaceutical framework which influence drug shortages. METHODS Different European and national legislations governing human medicinal products were analyzed (e.g. Directive 2001/83/EC and Directive 2011/62/EU), supplemented with literature studies. RESULTS For patented drugs, external price referencing may encompass the largest impact on drug shortages. For generic medicines, internal or external reference pricing, tendering as well as price capping may affect drug shortages. Manufacturing/quality requirements also contribute to drug shortages, since non-compliance leads to recalls. The influence of parallel trade on drug shortages is still rather disputable. CONCLUSION Price and quality regulations are both important causes of drug shortages or drug unavailability. It can be concluded that there is room for improvement in the pharmaceutical legal framework within the lines drawn by the EU to mitigate drug shortages.
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McLaughlin MM, Skoglund E, Pentoney Z, Scheetz MH. Developing a Method for Reporting Patient Harm Due to Antimicrobial Shortages. Infect Dis Ther 2014; 3:349-55. [PMID: 25234281 PMCID: PMC4269628 DOI: 10.1007/s40121-014-0040-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Indexed: 11/27/2022] Open
Abstract
Introduction The number of drug shortages in the United States has increased in recent years. While some literature exists on factors that contribute to antimicrobial shortages, the need remains to accurately gage the level of patient harm incurred as a result of realized antimicrobial shortages. Furthermore, current methods of reporting adverse drug events are known to under-report instances of patient harm. We sought to develop an ongoing and accurate method of reporting patient harm due to antimicrobial shortages, which was convenient, anonymous, and allowed clinicians to estimate the causality due to a shortage. Methods We distributed a public SurveyMonkey® (SurveyMonkey, Palo Alto, CA, USA) link to gather information regarding institution (for de-duplicating purposes), patient age, sex, antimicrobial product on shortage, type of infection requiring treatment or prophylaxis, adverse event, and patient outcome. Results To date complete data were reported on four patients being treated for infections that included Stenotrophomonas maltophilia bacteremia, Pneumocystis jirovecii pneumonia, neonatal sepsis of unknown etiology, and cytomegalovirus colitis. Antimicrobials that were unavailable to patients included sulfamethoxazole–trimethoprim, gentamicin, and foscarnet. Two adverse events (a delay in treatment and an inability to treat with other antimicrobials due to resistance) were attributed with probable causality due to a shortage, while the remaining adverse events (death and an inability to tolerate high oral doses) were attributed to have unlikely and possible causalities due to a shortage, respectively. Conclusion These methods encourage reports of antimicrobial shortage harms. Electronic supplementary material The online version of this article (doi:10.1007/s40121-014-0040-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Milena M McLaughlin
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Erik Skoglund
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Zachary Pentoney
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Marc H Scheetz
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA.
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA.
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Abstract
Drug shortages are a growing problem in developed countries. To some extent they are the result of technical and organisational failures, but to view drug shortages simply as technical and economic phenomena is to miss the fact that they are also ethical and political issues. This observation is important because it highlights both the moral and political imperative to respond to drug shortages as vigorously as possible, and the need for those addressing shortages to do so in ethically and politically sophisticated ways. This brief article outlines the ethical issues that need to be considered by anyone attempting to understand or address drug shortages.
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Affiliation(s)
- Wendy Lipworth
- Australian Institute of Health Innovation, University of New South Wales ; Centre for Values, Ethics and the Law in Medicine, University of Sydney
| | - Ian Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney ; Royal North Shore Hospital, Sydney
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Gholami K, Kamalinia G, Ahmadian Attari MM, Salamzadeh J. Three years evaluation of drug shortages from educational pharmacies in tehran. Iran J Pharm Res 2012; 11:565-72. [PMID: 24250480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effectiveness of any drug supply systems in providing a trustworthy supply of essential drugs is a critical issue. To evaluate this effectiveness, it is necessary to watch over the status of the essential medicines in any country impartially and continuously. Some countries and also the World Health Organization (WHO) have codified a list of minimum medicines needed for a basic health care system and published them in assortments as a list of essential medicines. The aim of this study was to give an evaluation of the shortages status in Iran and identify the strengths and weaknesses of policies made in Ministry of Health during the years 2005 to 2008 in providing the essential drugs based on the WHO list of essential medicines. The reports used in this retrospective study were collected from the central purchasing unit of one of the main chain drugstores in the country (13-Aban Pharmacy) every 2 to 3 weeks. In these reports, a drug is added to the list of shortages when the requested drug is not delivered. The reports were studied and the results were analyzed based on the WHO list of essential medicines and the national drug list of Iran. The shortages always included 20 to 40 medicines from the list of essential drugs compiled by WHO. Based on this finding, the Ministry of Health and particularly Food and Drug Organization can compile a National List of Essential Medicines and try to always supply them and prevent their shortage.
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