Research Article
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Opinions of pharmacists in Turkiye on drug shortages and effects on treatment

Year 2024, Volume: 44 Issue: 1, 18 - 28, 01.03.2024
https://doi.org/10.52794/hujpharm.1306922

Abstract

Drug shortage is defined as a lack of supply of a medicinal product that affects the patient’s ability to access the necessary treatment when they need it. The origins of this deficiency are complex and varied, and both supply and demand can cause the problem. This study determined the reasons for the drug shortages, their incidence, the most affected drug groups, the precautions taken, and their effects on treatment. The research is in a survey model and quantitative type. A questionnaire form prepared by the researchers was used as a data collection tool in the study. The questionnaire form was sent to community and hospital pharmacists via the Internet. Volunteers were asked to participate. 107 people, including 90 community pharmacists and 17 hospital pharmacists, participated in the research. In our study, the participants listed the essential causes of drug shortage as problems in the supply of raw materials (78.5%), production problems (53.3%), and increased demand for some drugs (29%). Early warning systems should be developed and integrated into relevant processes, ensuring a consistent supply of drugs to prevent drug shortages. Ensuring this structure requires the cooperation of all professionals, institutions, and organizations involved in the national and international health system.

References

  • 1. Vogler S, Kilpatrick K. Analysis of medicine prices in New Zealand and 16 European countries. Value in Health. 2015;18(4):484-492. https://doi.org/10.1016/j.jval.2015.01.003
  • 2. De Weerdt E, Simoens S, Casteels M, Huys I. Toward a European definition for a drug shortage: a qualitative study. Front Pharmacol. 2015;6:253. https://doi.org/10.3389/fphar.2015.00253
  • 3. 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(5):1210-1219. https://doi.org/10.1007/s11096-019-00889-1
  • 4. Acosta A, Vanegas EP, Rovira J, Godman B, Bochenek T. Medicine shortages: gaps between countries and global perspectives. Front Pharmacol. 2019;10:763. https://doi.org/10.3389/fphar.2019.00763
  • 5. WHO. Technical definitions on shortages and stockouts of medicines and vaccines. 2017. [cited March 2023]. Available from: https://www.who.int/publications/m/item/WHO-EMPIAU-2017.03
  • 6. 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(5):563-567. https://doi.org/10.1016/j.healthpol.2020.03.003
  • 7. Mayer DK. Anatomy of a drug shortage. Clin J Oncol. 2012;16(2):107-109. https://doi.org/10.1188/12.cjon.107-108
  • 8. Kaakeh R, Reilly C, DeLoach S, Clark AM. Impact of drug shortages on US health systems. 2011;68(19):1811-1819. https://doi.org/10.2146/ajhp110210
  • 9. McBride A, Westendorf C, Griffith N, Hoffman JM. National survey on the effect of oncology drug shortages on cancer care. AJHP 2013;70(7):609-617. https://doi.org/10.2146/ajhp120563
  • 10. Bochenek T, Abilova V, Alkan A, Asanin B, de Miguel Beriain I, Besovic Z, et al. Systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages in 28 European and Western Asian countries. Front Pharmacol. 2018;8:942. https://doi.org/10.3389/fphar.2017.00942
  • 11. Gray A, Manasse Jr HR. Shortages of medicines: a complex global challenge. Bull World Health Organ. 2012;90(3):158-158. https://doi.org/10.2471/blt.11.101303
  • 12. Steinbrook R. Drug shortages and public health. NEJM. 2009;361(16):1525-1527. https://doi.org/10.1056/nejmp0906922
  • 13. 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. 2016;22(6):766-770. https://doi.org/10.1177/1078155215610915
  • 14. Reed BN, Fox ER, Konig M, Jackevicius CA, Masoudi FA, Rabinstein AA, Page RL. The impact of drug shortages on patients with cardiovascular disease: causes, consequences, and a call to action. Am Heart J. 2016;175:130-141. https://doi.org/10.1016/j.ahj.2016.02.004
  • 15. De Weerdt E, Simoens S, Casteels M, Huys I. Clinical, economic and policy implications of drug shortages in the European Union. Appl Health Econ Health Policy. 2017;15:441–445. https://doi.org/10.1007/s40258-016-0264-z
  • 16. Pauwels K, Huys I, Casteels M, Simoens S. Drug shortages in European countries: a trade-off between market attractiveness and cost containment?. BMC Health Serv Res. 2014;14:438. https://doi.org/10.1186/1472-6963-14-438
  • 17. Fox ER, Sweet BV, Jensen V. Drug shortages: a complex health care crisis. Mayo Clin Proc. 2014;89(3):361-373. https://doi.org/10.1016/j.mayocp.2013.11.014
  • 18. McLaughlin M, Kotis D, Thomson K, Harrison M, Fennessy G, Postelnick M, et al. Empty shelves, full of frustration: consequences of drug shortages and the need for action. Hosp Pharm. 2013;48(8):617-618. https://doi.org/10.1310/hpj4808-617
  • 19. Costelloe EM, Guinane M, Nugent F, Halley O, Parsons C. An audit of drug shortages in a community pharmacy practice. Ir J Med Sci. 2015;184:435–440. https://doi.org/10.1007/s11845-014-1139-7
  • 20. Mazer-Amirshahi M, Pourmand A, Singer S, Pines JM, van den Anker J. Critical drug shortages: implications for emergency medicine. Acad Emerg Med. 2014;21(6):704-711. https://doi.org/10.1111/acem.12389
  • 21. Furlow B. Persistent drug shortages jeopardise patient safety in the USA. The Lancet Respiratory Medicine. 2015;3(3):182-183. https://doi.org/10.1016/S2213-2600(15)00053-3
  • 22. 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(12):1302-1309. https://doi.org/10.1016/j.healthpol.2018.09.005
  • 23. Pauwels K, Simoens S, Casteels M, Huys I. Insights into European drug shortages: a survey of hospital pharmacists. PLoS ONE. 2015;10(3):e0119322. https://doi.org/10.1371/journal.pone.0119322
  • 24. De Weerdt E, De Rijdt T, Simoens S, Casteels M, Huys I. Time spent by Belgian hospital pharmacists on supply disruptions and drug shortages: an exploratory study. PLoS ONE. 2017;12(3):e0174556. https://doi.org/10.1371/journal.pone.0174556
  • 25. De Weerdt E, Simoens S, Casteels M, Huys I. Time investment in drug supply problems by flemish community pharmacies. Front Pharmacol. 2017;8:568. https://doi.org/10.3389/fphar.2017.00568
  • 26. Foppe van Mil JW, Westerlund T, Brown L, Chen TF, Henman M, Hersberger K, et al. Medical care and drug-related problems: do doctors and pharmacists speak the same language?. Int J Clin Pharm. 2016;38:191–194. https://doi.org/10.1007/s11096-016-0249-x
  • 27. Fox ER, Birt A, James KB, Kokko H, Salverson S, Soflin DL. ASHP guidelines on managing drug product shortages in hospitals and health systems. AJHP. 2009;66(15):1399-1406. https://doi.org/10.2146/ajhp090026
  • 28. Cameron A, Roubos I, Ewen M, Mantel-Teeuwisse AK, Leufkens HG, Laing RO. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries. Bull World Health Organ. 2011;89:412-421. https://doi.org/10.2471/blt.10.084327
  • 29. Quick JD, Hogerzeil HV, Rankin JR, Dukes MNG, Laing R, Garnett A, et al. Managing Drug Supply: The Selection, Procurement, Distribution, and Use of Pharmaceuticals. Second ed. Connecticut: Kumarian Press; 1997.
  • 30. Balçık PY, Karsavuran S. Dünyada ve Türkiye›de ilaç fiyatlandırması. Hacettepe Sağlık İdaresi Dergisi. 2012;15(2):38-67.
  • 31. Mossialos E, Mrazek M, Walley T. Regulating Pharmaceuticals in Europe: Striving for Efficiency, Equity and Quality: Striving for Efficiency, Equity and Quality. London: McGraw-Hill Education; 2004.
  • 32. Sönmez S, İlgün G. Türkiye’de ilaç fiyatlandırma ve geri ödeme politikalarının AB ülkeleri ile karşılaştırılması. Sayıştay Dergisi. 2018;108:99-121.
  • 33. Turkish Medicines and Medical Devices Agency. Avro değeri. 2023. [cited March 2023]. Available from: https://www.titck.gov.tr/duyuru/avro-degeri-27122018173156
  • 34. Türkiye İlaç Sanayi Derneği. İlaç Fiyatlarında Uygulanan Dönemsel Avro Değeri (DAD) Bilgileri. 2023. [cited March 2023]. Available from: https://www.tisd.org.tr/DAD.aspx
  • 35.Çalışkan Z. Referans fiyat ve ilaç piyasası. Hacettepe Sağlık İdaresi Dergisi. 2008;11(1):49-75.
  • 36. Kontozamanis V, Mantzouneas E, Stoforos C. An overview of the Greek pharmaceutical market. HEPAC. 2003;4:327–333. https://doi.org/10.1007/s10198-003-0206-1
  • 37. Chaplin S. Medicine shortages as a result of parallel exporting to Europe. Prescriber. 2011;22(5):46-48. https://doi.org/10.1002/psb.725
  • 38. Ganslandt M, Maskus KE. Parallel imports and the pricing of pharmaceutical products: evidence from the European Union. J Health Econ. 2004;23(5):1035-1057. https://doi.org/10.1016/j.jhealeco.2004.03.005
  • 39. Bogaert P, Bochenek T, Prokop A, Pilc A. A qualitative approach to a better understanding of the problems underlying drug shortages, as viewed from Belgian, French and the European Union’s perspectives. PLoS ONE. 2015;10(5):e0125691. https://doi.org/10.1371/journal.pone.0125691
  • 40. McLaughlin M, Kotis D, Thomson K, Harrison M, Fennessy G, Postelnick M, et al. Effects on patient care caused by drug shortages: a survey. J Manag Care Pharm. 2013;19(9):783-788. https://doi.org/10.18553/jmcp.2013.19.9.783
  • 41. European Association of Hospital Pharmacists. Medicines Shortages. 2023. [cited March 2023]. Available from: https://www.eahp.eu/practice-and-policy/medicines-shortages
  • 42. Institute for Safe Medication Practices. Special Issue: Drug shortages: National Survey Reveals High Level of Frustration, Low Level of Safety. 2010. [cited March 2023]. Available from: https://www.ismp.org/resources/special-issue-drugshortages-national-survey-reveals-high-level-frustration-lowlevel
  • 43. Yang C, Wu L, Cai W, Zhu W, Shen Q, Li Z, et al. Current situation, determinants, and solutions to drug shortages in Shaanxi Province, China: a qualitative study. PLoS ONE. 2016;11(10):e0165183. https://doi.org/10.1371/journal.pone.0165183

Opinions of pharmacists in Turkiye on drug shortages and effects on treatment

Year 2024, Volume: 44 Issue: 1, 18 - 28, 01.03.2024
https://doi.org/10.52794/hujpharm.1306922

Abstract

Drug shortage is defined as a lack of supply of a medicinal product that affects the patient’s ability to access the necessary treatment when they need it. The origins of this deficiency are complex and varied, and both supply and demand can cause the problem. This study determined the reasons for the drug shortages, their incidence, the most affected drug groups, the precautions taken, and their effects on treatment. The research is in a survey model and quantitative type. A questionnaire form prepared by the researchers was used as a data collection tool in the study. The questionnaire form was sent to community and hospital pharmacists via the Internet. Volunteers were asked to participate. 107 people, including 90 community pharmacists and 17 hospital pharmacists, participated in the research. In our study, the participants listed the essential causes of drug shortage as problems in the supply of raw materials (78.5%), production problems (53.3%), and increased demand for some drugs (29%). Early warning systems should be developed and integrated into relevant processes, ensuring a consistent supply of drugs to prevent drug shortages. Ensuring this structure requires the cooperation of all professionals, institutions, and organizations involved in the national and international health system.

References

  • 1. Vogler S, Kilpatrick K. Analysis of medicine prices in New Zealand and 16 European countries. Value in Health. 2015;18(4):484-492. https://doi.org/10.1016/j.jval.2015.01.003
  • 2. De Weerdt E, Simoens S, Casteels M, Huys I. Toward a European definition for a drug shortage: a qualitative study. Front Pharmacol. 2015;6:253. https://doi.org/10.3389/fphar.2015.00253
  • 3. 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(5):1210-1219. https://doi.org/10.1007/s11096-019-00889-1
  • 4. Acosta A, Vanegas EP, Rovira J, Godman B, Bochenek T. Medicine shortages: gaps between countries and global perspectives. Front Pharmacol. 2019;10:763. https://doi.org/10.3389/fphar.2019.00763
  • 5. WHO. Technical definitions on shortages and stockouts of medicines and vaccines. 2017. [cited March 2023]. Available from: https://www.who.int/publications/m/item/WHO-EMPIAU-2017.03
  • 6. 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(5):563-567. https://doi.org/10.1016/j.healthpol.2020.03.003
  • 7. Mayer DK. Anatomy of a drug shortage. Clin J Oncol. 2012;16(2):107-109. https://doi.org/10.1188/12.cjon.107-108
  • 8. Kaakeh R, Reilly C, DeLoach S, Clark AM. Impact of drug shortages on US health systems. 2011;68(19):1811-1819. https://doi.org/10.2146/ajhp110210
  • 9. McBride A, Westendorf C, Griffith N, Hoffman JM. National survey on the effect of oncology drug shortages on cancer care. AJHP 2013;70(7):609-617. https://doi.org/10.2146/ajhp120563
  • 10. Bochenek T, Abilova V, Alkan A, Asanin B, de Miguel Beriain I, Besovic Z, et al. Systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages in 28 European and Western Asian countries. Front Pharmacol. 2018;8:942. https://doi.org/10.3389/fphar.2017.00942
  • 11. Gray A, Manasse Jr HR. Shortages of medicines: a complex global challenge. Bull World Health Organ. 2012;90(3):158-158. https://doi.org/10.2471/blt.11.101303
  • 12. Steinbrook R. Drug shortages and public health. NEJM. 2009;361(16):1525-1527. https://doi.org/10.1056/nejmp0906922
  • 13. 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. 2016;22(6):766-770. https://doi.org/10.1177/1078155215610915
  • 14. Reed BN, Fox ER, Konig M, Jackevicius CA, Masoudi FA, Rabinstein AA, Page RL. The impact of drug shortages on patients with cardiovascular disease: causes, consequences, and a call to action. Am Heart J. 2016;175:130-141. https://doi.org/10.1016/j.ahj.2016.02.004
  • 15. De Weerdt E, Simoens S, Casteels M, Huys I. Clinical, economic and policy implications of drug shortages in the European Union. Appl Health Econ Health Policy. 2017;15:441–445. https://doi.org/10.1007/s40258-016-0264-z
  • 16. Pauwels K, Huys I, Casteels M, Simoens S. Drug shortages in European countries: a trade-off between market attractiveness and cost containment?. BMC Health Serv Res. 2014;14:438. https://doi.org/10.1186/1472-6963-14-438
  • 17. Fox ER, Sweet BV, Jensen V. Drug shortages: a complex health care crisis. Mayo Clin Proc. 2014;89(3):361-373. https://doi.org/10.1016/j.mayocp.2013.11.014
  • 18. McLaughlin M, Kotis D, Thomson K, Harrison M, Fennessy G, Postelnick M, et al. Empty shelves, full of frustration: consequences of drug shortages and the need for action. Hosp Pharm. 2013;48(8):617-618. https://doi.org/10.1310/hpj4808-617
  • 19. Costelloe EM, Guinane M, Nugent F, Halley O, Parsons C. An audit of drug shortages in a community pharmacy practice. Ir J Med Sci. 2015;184:435–440. https://doi.org/10.1007/s11845-014-1139-7
  • 20. Mazer-Amirshahi M, Pourmand A, Singer S, Pines JM, van den Anker J. Critical drug shortages: implications for emergency medicine. Acad Emerg Med. 2014;21(6):704-711. https://doi.org/10.1111/acem.12389
  • 21. Furlow B. Persistent drug shortages jeopardise patient safety in the USA. The Lancet Respiratory Medicine. 2015;3(3):182-183. https://doi.org/10.1016/S2213-2600(15)00053-3
  • 22. 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(12):1302-1309. https://doi.org/10.1016/j.healthpol.2018.09.005
  • 23. Pauwels K, Simoens S, Casteels M, Huys I. Insights into European drug shortages: a survey of hospital pharmacists. PLoS ONE. 2015;10(3):e0119322. https://doi.org/10.1371/journal.pone.0119322
  • 24. De Weerdt E, De Rijdt T, Simoens S, Casteels M, Huys I. Time spent by Belgian hospital pharmacists on supply disruptions and drug shortages: an exploratory study. PLoS ONE. 2017;12(3):e0174556. https://doi.org/10.1371/journal.pone.0174556
  • 25. De Weerdt E, Simoens S, Casteels M, Huys I. Time investment in drug supply problems by flemish community pharmacies. Front Pharmacol. 2017;8:568. https://doi.org/10.3389/fphar.2017.00568
  • 26. Foppe van Mil JW, Westerlund T, Brown L, Chen TF, Henman M, Hersberger K, et al. Medical care and drug-related problems: do doctors and pharmacists speak the same language?. Int J Clin Pharm. 2016;38:191–194. https://doi.org/10.1007/s11096-016-0249-x
  • 27. Fox ER, Birt A, James KB, Kokko H, Salverson S, Soflin DL. ASHP guidelines on managing drug product shortages in hospitals and health systems. AJHP. 2009;66(15):1399-1406. https://doi.org/10.2146/ajhp090026
  • 28. Cameron A, Roubos I, Ewen M, Mantel-Teeuwisse AK, Leufkens HG, Laing RO. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries. Bull World Health Organ. 2011;89:412-421. https://doi.org/10.2471/blt.10.084327
  • 29. Quick JD, Hogerzeil HV, Rankin JR, Dukes MNG, Laing R, Garnett A, et al. Managing Drug Supply: The Selection, Procurement, Distribution, and Use of Pharmaceuticals. Second ed. Connecticut: Kumarian Press; 1997.
  • 30. Balçık PY, Karsavuran S. Dünyada ve Türkiye›de ilaç fiyatlandırması. Hacettepe Sağlık İdaresi Dergisi. 2012;15(2):38-67.
  • 31. Mossialos E, Mrazek M, Walley T. Regulating Pharmaceuticals in Europe: Striving for Efficiency, Equity and Quality: Striving for Efficiency, Equity and Quality. London: McGraw-Hill Education; 2004.
  • 32. Sönmez S, İlgün G. Türkiye’de ilaç fiyatlandırma ve geri ödeme politikalarının AB ülkeleri ile karşılaştırılması. Sayıştay Dergisi. 2018;108:99-121.
  • 33. Turkish Medicines and Medical Devices Agency. Avro değeri. 2023. [cited March 2023]. Available from: https://www.titck.gov.tr/duyuru/avro-degeri-27122018173156
  • 34. Türkiye İlaç Sanayi Derneği. İlaç Fiyatlarında Uygulanan Dönemsel Avro Değeri (DAD) Bilgileri. 2023. [cited March 2023]. Available from: https://www.tisd.org.tr/DAD.aspx
  • 35.Çalışkan Z. Referans fiyat ve ilaç piyasası. Hacettepe Sağlık İdaresi Dergisi. 2008;11(1):49-75.
  • 36. Kontozamanis V, Mantzouneas E, Stoforos C. An overview of the Greek pharmaceutical market. HEPAC. 2003;4:327–333. https://doi.org/10.1007/s10198-003-0206-1
  • 37. Chaplin S. Medicine shortages as a result of parallel exporting to Europe. Prescriber. 2011;22(5):46-48. https://doi.org/10.1002/psb.725
  • 38. Ganslandt M, Maskus KE. Parallel imports and the pricing of pharmaceutical products: evidence from the European Union. J Health Econ. 2004;23(5):1035-1057. https://doi.org/10.1016/j.jhealeco.2004.03.005
  • 39. Bogaert P, Bochenek T, Prokop A, Pilc A. A qualitative approach to a better understanding of the problems underlying drug shortages, as viewed from Belgian, French and the European Union’s perspectives. PLoS ONE. 2015;10(5):e0125691. https://doi.org/10.1371/journal.pone.0125691
  • 40. McLaughlin M, Kotis D, Thomson K, Harrison M, Fennessy G, Postelnick M, et al. Effects on patient care caused by drug shortages: a survey. J Manag Care Pharm. 2013;19(9):783-788. https://doi.org/10.18553/jmcp.2013.19.9.783
  • 41. European Association of Hospital Pharmacists. Medicines Shortages. 2023. [cited March 2023]. Available from: https://www.eahp.eu/practice-and-policy/medicines-shortages
  • 42. Institute for Safe Medication Practices. Special Issue: Drug shortages: National Survey Reveals High Level of Frustration, Low Level of Safety. 2010. [cited March 2023]. Available from: https://www.ismp.org/resources/special-issue-drugshortages-national-survey-reveals-high-level-frustration-lowlevel
  • 43. Yang C, Wu L, Cai W, Zhu W, Shen Q, Li Z, et al. Current situation, determinants, and solutions to drug shortages in Shaanxi Province, China: a qualitative study. PLoS ONE. 2016;11(10):e0165183. https://doi.org/10.1371/journal.pone.0165183
There are 43 citations in total.

Details

Primary Language English
Subjects Pharmacology and Pharmaceutical Sciences
Journal Section Research Articles
Authors

Muammer Çalıkuşu 0000-0002-3249-4936

Gülbin Özçelikay 0000-0002-1580-5050

Publication Date March 1, 2024
Acceptance Date February 6, 2024
Published in Issue Year 2024 Volume: 44 Issue: 1

Cite

Vancouver Çalıkuşu M, Özçelikay G. Opinions of pharmacists in Turkiye on drug shortages and effects on treatment. HUJPHARM. 2024;44(1):18-2.