Collaborative Management Strategies for Drug Shortages in Neurocritical Care

Clark, Sarah L.; Levasseur-Franklin, Kimberly; Pajoumand, Mehrnaz; Barra, Megan E.; Armahizer, Michael; Patel, Deepa; Chester, Katleen; Tully, Andrea

doi:10.1007/s12028-019-00730-7

Cited by 11 publications

(7 citation statements)

References 46 publications

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“…Shortages occur of commonly used medicines, such as medicines affecting the nervous system and the cardiovascular system. These results are consistent with earlier studies conducted in Finland ( Heiskanen et al, 2015 ; Tapanila et al, 2021 ) and other countries (e.g., Pauwels et al, 2014 ; Dave et al, 2018 ; Videau et al, 2019 ; Benhabib et al, 2020 ; Clark et al, 2020 ). Even though shortages can often be resolved with alternative, interchangeable products and patients are rarely left without medicines ( Heiskanen et al, 2015 ; Tapanila et al, 2021 ), they still burden the health care system and health professionals in their daily work, resulting also to possible increase in medicine prices ( Fox and Tyler 2017 ) and undoubtedly an increase to pharmaceutical expenditure ( Blankart and Felder 2022 ).…”

Section: Discussionsupporting

confidence: 93%

Medicine shortages: Product life cycle phases and characteristics of medicines in short supply—A register study

2022

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Introduction: Product life cycle refers to all phases of a product from development to active market phase and finally the phase in which products possibly exit the market. The product life cycle of medicines in short supply has not been studied in depth, although there is some indication of mature products and products with lower prices and profit margins being exposed to shortages more often. The aim of this study was to examine the product life cycle phases and characteristics of medicines in short supply as well as the features of medicine shortages in Finland from 2017 to 2019.Material and methods: Register data on medicine shortages of human medicinal products from 2017 to 2019 was combined with timely data on marketing authorizations and reimbursement status to gain data on product life cycle phases and characteristics (e.g., the age and the reimbursement status) of medicines in short supply and the features of medicine shortages. The data were analyzed in descriptive manner using appropriate statistical testing.Results: 3,526 shortages were reported during the 3-year study period and the number of shortages increased annually. The average duration of a shortage was 83 days and shortages affected 660 active pharmaceutical ingredients. Most often, shortages occurred with medicines affecting the nervous system, the cardiovascular system, and the genitourinary system. A majority of shortages (n = 2,689) was reported in the reimbursable medicines group, where shortages increased as the number of patients receiving reimbursements increased (p < 0.001). In the reimbursable medicines group, shortages most commonly involved medicines aged 15–19, 20–24, and 25–29, whereas with both reimbursable and non-reimbursable products the shortages most often occurred in medicines aged 50–54. The frequency of shortages differed between the groups (p < 0.001) when both age and reimbursement status were taken into account.Conclusion: Medicine shortages are common and affect commonly used medicines. Product life cycle phase has an effect on the frequency of shortages: Reimbursable medicines and medicines exposed to changes in life cycle are more likely to face a shortage. The impacts of product life cycle on the availability of medicines and medicine shortages should be studied in more detail.

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Section: Discussionsupporting

confidence: 93%

Medicine shortages: Product life cycle phases and characteristics of medicines in short supply—A register study

2022

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“…In low-income countries, literature cited medicines used for TB, Malaria, and HIV due to the increased incidence of these diseases and the unavailability of essential drugs rather than drug shortages or stock-out. Table 1 shows the medicines affected by shortages in different countries (Elbagir et al, 1995;Kangwana et al, 2009;Tren et al, 2009;Ballinger, 2010;Ventola, 2011;Griffith et al, 2012;Liang and Mackey, 2012;Malik et al, 2013;Quilty, 2014;Ricci et al, 2016;Donohue and Angus, 2017;Gross et al, 2017;Hsueh et al, 2017;Meloni et al, 2017;Tan et al, 2017;Vail et al, 2017;Banerjee et al, 2018;Dave et al, 2018;Gundlapalli et al, 2018;Holcombe et al, 2018;Said et al, 2018;Benge and Burka, 2019;Visage et al, 2019;Yellapu et al, 2019;Benhabib et al, 2020;Choo and Rajkumar, 2020;Clark et al, 2020;Honda et al, 2020;Siow et al, 2020;Sun et al, 2020;Mclaughlin et al, 2017;Dave et al, 2018).…”

Section: Drugs Reported In Shortagementioning

confidence: 99%

Drug Shortage: Causes, Impact, and Mitigation Strategies

et al. 2021

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Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.

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“…Opioid shortages have occurred due to supply chain disturbances. These situations necessitate the optimization of non-pharmacological therapies and prioritizing indications for opioid use 9 . Screening colonoscopies would be considered low priority, and VR could play an important role in mitigating colonoscopy-associated pain and anxiety during these times.…”

Section: Discussionmentioning

confidence: 99%

A pilot study of virtual reality as an alternative to pharmacological sedation during colonoscopy

Friedman

Rand²,

Patel³

et al. 2021

Endosc Int Open

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Background and study aims Conscious sedation is routinely administered for colonoscopy but is associated with risks and inconveniences. We sought to determine whether virtual reality (VR) may be a feasible alternative. Patients and methods Twenty-seven individuals scheduled for screening/surveillance colonoscopy participated. The VR device was activated throughout the colonoscopy, but subjects could opt out and request standard medications. Questionnaires were administered, and variables were assessed on a scale of 1 to 10. Results Cecal intubation was achieved in all cases without adverse events (AEs). Study colonoscopies were completed without pharmacological rescue in 26 of 27 patients (96.3 %) and procedure times were comparable to baseline. Subjects reported minimal pain, high satisfaction, and willingness to use VR for future colonoscopies to avoid narcotics and resume normal activities including driving. Conclusion Replacing pharmacological sedation with VR did not impact colonoscopy completion rates, procedure time, or AEs. Satisfaction was high and only one subject (3.7 %) chose to suspend VR. VR can be an effective alternative for patients undergoing colonoscopy who prefer to avoid narcotics.

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Collaborative Management Strategies for Drug Shortages in Neurocritical Care

Cited by 11 publications

References 46 publications

Medicine shortages: Product life cycle phases and characteristics of medicines in short supply—A register study

Medicine shortages: Product life cycle phases and characteristics of medicines in short supply—A register study

Drug Shortage: Causes, Impact, and Mitigation Strategies

A pilot study of virtual reality as an alternative to pharmacological sedation during colonoscopy

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