Hospital pharmacy directors call for more efficient allocation systems – sciencedaily


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Despite continued efforts to develop efficient, practical and ethical allocation systems for drug shortages, a national survey found that 81 percent of hospital pharmacy managers had experienced drug accumulation. All of the pharmacy managers reported drug shortages in the past year. More than two-thirds reported “more than 50 shortages”.

In their research letter published in the March 25, 2019 issue of JAMA Internal Medicine, a team of ethicists, oncologists and a pharmacist presented the results of their investigation. Their goal was to find out how common drug shortages were, which hospitals were most affected, and how hospitals were planning and managing drug shortages.

The authors launched their survey to study how US hospitals cope with the current challenges of drug allocation during shortages. They sent a 19-item questionnaire to 1,100 directors of pharmaceutical practices and pharmacy executives who are members of the American Society of Health System Pharmacists. Sixty-five percent, or 719 people, responded.

“All stakeholders have reported drug shortages over the past year,” said Andrew Hantel, MD, corresponding study author and researcher in hematology / oncology and medical ethics at the University of Medicine of Chicago. Almost 500 directors of pharmaceutical firms (about 70 percent) reported more than 50 shortages. Most respondents said it was less than a month between learning that a drug was scarce and having a shortage in their hospital.

“In order to create a survey with questions relevant to our respondents, we conducted semi-structured interviews beforehand to understand pharmacists’ experiences with drug shortages,” Hantel said. “We systematically analyzed this qualitative data and tested the clarity and consistency of the questions before sending out the survey. “

One in three pharmacists surveyed said their hospital had no valid administrative mechanism to help them cope with a shortage. “More than 80 percent have reported hoarding drugs in response to shortages,” Hantel said.

They found that at least one episode of rationing had occurred in the past year in more than a third of hospitals. This was more common in teaching hospitals and their subsidiaries than in community hospitals.

Unfortunately, such shortages are common. The American Society for Hospital Pharmacists (ASHP) maintains a list of candidates. Currently, 226 drugs, ranging from abciximab injection to yellow fever vaccine, are in short supply. The manufacturer of abciximab (ReoPro®), a drug used to prevent ischemic heart complications, “cannot guarantee continuity of supply.” There are no other providers. The yellow fever vaccine supplier points to “production delays”. Again, there is no backup source for the drug.

In severe cases, the authors note, shortages force clinicians to decide “which patients receive needed drugs and which patients do not, which can lead to drug rationing between patients.” Disclosure of rationing to patients, the authors note, “was not common.”

“Our investigation,” Hantel added, “suggests that more systematic approaches are needed to address the problem and reduce the need for rationing.

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Material provided by University of Chicago Medical Center. Note: Content can be changed for style and length.

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