The impacts of medication shortages on patient outcomes: A scoping review

Abstract

Background In recent years, medication shortages have become a growing worldwide issue. This scoping review aimed to systematically synthesise the literature to report on the economic, clinical, and humanistic impacts of medication shortages on patient outcomes. Methods Medline, Embase, Global Health, PsycINFO and International Pharmaceutical Abstracts were searched using the two key concepts of medicine shortage and patient outcomes. Articles were limited to the English language, human studies and there were no limits to the year of publication. Manuscripts included contained information regarding the shortage of a scheduled medication and had gathered data regarding the economic, clinical, and/or humanistic outcomes of drug shortages on human patients. Findings We found that drug shortages were predominantly reported to have adverse economic, clinical and humanistic outcomes to patients. Patients were more commonly reported to have increased out of pocket costs, rates of drug errors, adverse events, mortality, and complaints during times of shortage. There were also reports of equivalent and improved patient outcomes in some cases. Conclusions The results of this review provide valuable insights into the impact drug shortages have on patient outcomes. The majority of studies reported medication shortages resulted in negative patient clinical, economic and humanistic outcomes.

Prospective Risk Assessment of Medicine Shortages in Europe and Israel: Findings and Implications

“…Ultimately, the majority of participants share the view that not exposing patients to harm stemming from medicine shortages is the main outcome of successfully-led mitigation. In order to assess if there may be any harm to patients originating from shortages, it is important to tailor tools that could assist in recording and sharing the impact of shortages as well to create treatment guidelines addressing shortages (Phuong et al, 2019). This includes potential replacement treatments when the need arises.…”

“…Medicine shortages have a direct impact on patient outcomes through disrupting the continuity of patient care and potentially deteriorating treatment outcomes originating from timely scarcity of drug supply and substitution with a less safe and effective alternative and the potential for medication errors (Iyengar et al, 2016;De Weerdt et al, 2017;Rinaldi et al, 2017;France Assos Santé, 2018;Phuong et al, 2019). Consequently, risk management plays an important role in healthcare settings via minimizing the likelihood of identified risk-related consequences associated with drug shortages (The Australian Council on Healthcare Standards (ACHS), 2013; Iyengar et al, 2016;American Society of Health-System Pharmacists, 2018;Root, 2018).…”

Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals

“…Because the substitute might not be available to be prescribed/ordered when using the hospital's IT system, such information should be synchronized with availability and be easily accessible via databases instead of time-consuming processes via two-way telephone conversations or email contact. Not knowing the available substitute may jeopardize and delay patient treatment and consequently undermine health outcomes (15,42,43).…”

New regulatory strategies to manage medicines shortages in Europe

“…Such strategies cannot be applied to solve all shortage types, and the communications/cooperation among stakeholders may be limited. However, in the end, the existing problem-solving strategies aimed to face the same issue: the medicine unavailability for the patients and the increased risks for their health (Phuong et al, 2019). Consequently, in the estimation of the shortage impact on the patient needs, this aspect should be primary for harmonizing the existing metrics and rationalizing the problem-solving strategies to be adopted.…”