Skip to main content

Advertisement

SpringerLink
Log in

Medicine shortages in Australia: causes, impact and management strategies in the community setting

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Medicine shortages are an ongoing global problem. The Therapeutic Goods Administration (TGA) dedicated a website for monitoring of medicine shortages in Australia in May 2014, as part of the Medicine Shortage Information Initiative. This study aimed to explore the views of pharmacists regarding medicine shortages in the community setting and the impact of the TGA website in Australia. Setting Community pharmacies in New South Wales, Australia. Method Twenty semi-structured interviews were conducted with community pharmacists. Data collected were analysed thematically utilising the framework analysis method. Main outcome measure Qualitative analysis conducted using the framework approach. Results Findings clearly indicated that medicine shortages were experienced on a regular basis, but most participants were unaware of the TGA website. Medicine shortages reportedly impacted both pharmacists and consumers; and various workarounds were undertaken to manage the issue. The “price disclosure policy” was found to be a prominent contributing factor in emerging shortages. Suggestions were made for ways to improve the growing occurrence of shortages. Conclusion Overall, the study found that there was a lack of familiarity with the TGA website, despite experiencing regular shortages of medicines in practice. Also highlighted, was the importance of pharmacists prioritising patient care over business decisions. To reduce prescribing of out-of-stock medicines notifying doctors about shortages was also considered important, to allow for early action to be taken at higher levels of the supply chain. Findings of this study may help direct future policy-making around the world, as medicine shortages is a problem shared by healthcare providers in most countries around the world.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Talsma J. Drug shortages still at crisis levels. Drug Top. 2013;157(6):32.

    Google Scholar 

  2. Boyle K. Drug shortages: Canadian strategies for a complex global problem. Health Manage Forum. 2012;25:S48–58.

    Article  Google Scholar 

  3. Johnson PJ. The ongoing drug shortage problem affecting the NICU. Neonatal Netw. 2012;31:323–7.

    Article  PubMed  Google Scholar 

  4. Krisl JC, Fortier CR, Taber DJ. Disruptions in the supply of medications used in transplantation: Implications and management strategies for the transplant clinician. Am J Transplant. 2013;13:20–30.

    Article  CAS  PubMed  Google Scholar 

  5. Hoffman S. The drugs stop here: a public health framework to address the drug shortage crisis. Food Drug Law J. 2012;67:1–21.

    PubMed  Google Scholar 

  6. Griffith MM, Gross AE, Sutton SH, Bolon MK, Esterly JS, Patel JA, et al. The impact of anti-infective drug shortages on hospitals in the United States: trends and causes. Clin Infect Dis. 2012;54:684–91.

    Article  PubMed  Google Scholar 

  7. Fox ER, Sweet BV, Jensen V. Drug shortages: a complex health care crisis. Mayo Clin Proc. 2014;89:361–73.

    Article  PubMed  Google Scholar 

  8. Gatesman ML, Smith TJ. The shortage of essential chemotherapy drugs in the United States. N Engl J Med. 2011;365:1653–5.

    Article  CAS  PubMed  Google Scholar 

  9. Quilty S, Harris LM, Kewley J, Jones A, Pearce R, James R, et al. A Pandora’s box: sustainable pharmaceutical supply. Med J Aust. 2011;195:510–1.

    Article  PubMed  Google Scholar 

  10. Goldblatt J, Fletcher JM, McGill J, Szer J, Wilson M. Enzyme replacement therapy “drug holiday”: Results from an unexpected shortage of an orphan drug supply in Australia. Blood Cells Mol Dis. 2011;46:107–10.

    Article  PubMed  Google Scholar 

  11. Goldsack JC, Reilly C, Bush C, McElligott S, Bristol MN, Motanya UN, et al. Impact of shortages of injectable oncology drugs on patient care. Am J Health Sys Pharm. 2014;71:571–8.

    Article  Google Scholar 

  12. Gagnon MA. Drug shortages: searching for a cure. Healthc Policy. 2012;7(4):10–7.

    PubMed  PubMed Central  Google Scholar 

  13. Huys I, Simoens S. Editorial: European drug shortages: a call for action! Int J Pharm Pract. 2013;21:1–2.

    Article  PubMed  Google Scholar 

  14. Quilty S. Medicines shortages in Australia—the reality. Australas Med J. 2014;7(6):240–2.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Thompson CA. New FDA law will help preserve production of “life-saving” drugs. Am J Health Sys Pharm. 2012;69:1352–4.

    Google Scholar 

  16. US Food and Drug Administration. [Internet]. Current drug shortages; 2015. [Cited 26 Oct 2015]. http://www.accessdata.fda.gov/scripts/drugshortages/default.cfm.

  17. American Society of Health-System Pharmacists. [Internet]. Drug Shortages: Current Shortages; 2015. [Cited 2015 Oct 26]. http://www.ashp.org/menu/DrugShortages/CurrentShortages.

  18. Chaar BB. Medicine shortages: Implications for the Australian healthcare system. Australas Med J. 2014;7(3):161–3.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Australian Government. [Internet]. Department of Health Therapeutic Goods Administration; 2015. [Cited 2015 Oct 26]. http://www.tga.gov.au/hp/MSI/search/.

  20. Bogucki B, Jacobs BR, Hingle J. Computerized reminders reduce the use of medications during shortages. J Am Med Inform Assoc. 2004;11(4):278–80.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Becker DJ, Talwar S, Levy BP, Thorn M, Roitman J, Blum RH, et al. Impact of oncology drug shortages on patient therapy: unplanned treatment changes. Am Soc Clin Oncol. 2013;9:e122–8.

    Google Scholar 

  22. De Oliveira Jr GS, Theilken LS, McCarthy RJ. Shortage of perioperative drugs: implications for anesthesia practice and patient safety. Anesth Analg. 2011;113:1429–35.

    Article  Google Scholar 

  23. Australian Institute of Health and Welfare. [Internet]. Admitted patient care 2013–2014: Australian hospital statistics; 2015. [Cited 2015 Oct 26]. http://www.aihw.gov.au/publication-detail/?id=60129550483.

  24. The Pharmacy Guild of Australia. [Internet]. Serving Australians: a system of community pharmacy; 2012. [Cited 2015 Oct 26]. http://www.guild.org.au/docs/default-source/public-documents/issues-and-resources/Fact-Sheets/serving-australians-a-system-of-communtiy-pharmacy.pdf?sfvrsn=0.

  25. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analyzing qualitative data. London: Routledge; 1994. p. 173–94.

    Chapter  Google Scholar 

  26. Clarke PM. Challenges and opportunities for the Pharmaceutical Benefits Scheme. Med J Aust. 2012;196:153–4.

    Article  PubMed  Google Scholar 

  27. Searles A, Jefferys S, Doran E, Henry DA. Reference pricing, generic drugs and proposed changes to the Pharmaceutical Benefits Scheme. Med J Aust. 2007;187(4):236–9.

    PubMed  Google Scholar 

  28. Kaakeh R, Sweet BV, Reilly C, Bush C, DeLoach S, Higgins B, et al. Impact of drug shortages. Am J Health Sys Pharm. 2011;68(19):1811–9.

    Article  Google Scholar 

  29. Roberts R, Ruthazer R, Chi A, Grover A, Newman M, Bhat S, et al. Impact of a national propofol shortage on duration of mechanical ventilation at an academic medical center. Crit Care Med. 2012;40(2):406–11.

    Article  PubMed  Google Scholar 

  30. Metzger ML, Billett A, Link MP. The impact of drug shortages on children with cancer—The example of mechlorethamine. New Engl J Med. 2012;367:2461–3.

    Article  CAS  PubMed  Google Scholar 

  31. Ralls MW, Blackwood RA, Arnold MA, Partipilo ML, Dimond J, Teitelbaum DH. Drug shortage-associated increase in catheter-related blood stream infection in children. Pediatrics. 2012;130:e1369–73.

    Article  PubMed  Google Scholar 

  32. Baumer AM, Clark AM, Witmer DR, Geize SB, Vermeulen LC, Deffenbaugh JH. National survey of the impact of drug shortages in acute care hospitals. Am J Health Sys Pharm. 2004;61(19):2015–22.

    Google Scholar 

  33. Pauwels K, Simoens S, Casteels M, Huys I. Insights in European drug shortages: a survey of hospital pharmacists. Value Health. 2014;17:A14.

    Article  Google Scholar 

  34. Gholami K, Kamalinia G, Attari MMA, Salamzadeh J. Three years evaluation of drug shortages from educational pharmacies in Tehran. Iran J Pharm Res. 2012;11:565–72.

    PubMed  PubMed Central  Google Scholar 

  35. Davis C, Javid PJ, Horslen S. Selenium deficiency in pediatric patients with intestinal failure as a consequence of drug shortage. J Parenter Enteral Nutr. 2013;38:115–8.

    Article  Google Scholar 

  36. Sheth HS, Verrico MM, Skledar SJ, Towers AL. Promethazine adverse events after implementation of a medication shortage interchange. Ann Pharmacother. 2005;39(2):255–61.

    Article  CAS  PubMed  Google Scholar 

  37. Hayes MS, Ward MA, Slabaugh SL, Xu Y. Lessons from the leucovorin shortages between 2009 and 2012 in a medicare advantage population: where do we go from here? Am Health Drug Benefits. 2014;7:264–70.

    PubMed  PubMed Central  Google Scholar 

  38. Skelton Duke M, Chambliss WG, Gardner KN, Norris DM. Mitigating the impact of medication shortages on public health. J Am Pharm Assoc. 2011;51:574–8.

    Article  Google Scholar 

  39. Golembiewski J. Drug shortages in the perioperative setting: causes, impact, and strategies. J Perianesth Nurs. 2012;27:286–92.

    Article  PubMed  Google Scholar 

  40. Gundlapalli AV, Beekmann SE, Graham DR, Polgreen PM. Perspectives and concerns regarding antimicrobial agent shortages among infectious disease specialists. Diagn Microbiol Infect Dis. 2013;75(3):256–9.

    Article  PubMed  Google Scholar 

  41. Fox ER, Birt A, James KB, Kokko H, Salverson S, Soflin DL, et al. ASHP guidelines on managing drug product shortages in hospitals and health systems. Am J Health Sys Pharm. 2009;66:1399–406.

    Article  Google Scholar 

  42. Weaver JM. Why are there so many drug shortages? Anesth Prog. 2010;57:89–90.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Lee Ventola C. The drug shortage crisis in the United States causes, impact, and management strategies. Pharm Ther. 2011;36:740–57.

    Google Scholar 

  44. Jensen V, Kimzey LM, Goldberger MJ. FDA’s role in responding to drug shortages. Am J Health Sys Pharm. 2002;59:1423–5.

    Google Scholar 

  45. Born K. Time and money: an analysis of the legislative efforts to address the prescription drug shortage crisis in America. J Leg Med. 2012;33:235–51.

    Article  PubMed  Google Scholar 

  46. American Society of Health-System Pharmacists. [Internet]. current shortages: chloroquine tablets; 2015. [Cited 2015 Oct 26]. http://www.ashp.org/menu/DrugShortages/CurrentShortages/Bulletin.aspx?id=1178.

  47. US Food and Drug Administration. [Internet]. Current drug shortages: chloroquine phosphate tablets; 2015. [Cited 2015 Oct 31]. http://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Chloroquine Phosphate Tablets&st = c&tab = tabs-1.

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Faculty of Pharmacy, The University of Sydney, A15 Pharmacy and Bank Building, Sydney, NSW, 2006, Australia

    Yee Xi Tan, Rebekah J. Moles & Betty B. Chaar

Authors
  1. Yee Xi Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebekah J. Moles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Betty B. Chaar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Betty B. Chaar.

Ethics declarations

Conflicts of interest

None.

Appendix: Interview protocol (for both close and remote areas)

Appendix: Interview protocol (for both close and remote areas)

Step 1

Introduction and greeting.

Step 2

Reiteration of participation options (withdrawal etc.), organise consent form signing and ask for permission to start audio recording.

If participant is in a remote area and the interview is conducted via telephone: Particular care will be taken in acquiring the participant’s express consent [written consent already received prior to the interview] on the record in accordance with the relevant legislation [Telecommunications Act 1997 (CTH) and Listening Devices Act 1984 (NSW)] which prohibits recording of phone interviews without the express consent of all parties.

Step 3

Start interview and allow participant to speak without prompts. Use prompts only if the flow lulls somewhat.

Interview questions

  1. 1.

    What are your general thoughts about medicine shortages?

    Prompts:

    1. a.

      Do you experience medicine shortages in your practice?

    2. b.

      How often do shortages occur in your practice?

    3. c.

      What do you know about the causes of medicine shortages?

    4. d.

      What are the implications and effect on practice of medicine shortages?

  2. 2.

    Do you ever use the TGA website dedicated for notification of shortages?

    Prompts:

    1. a.

      When would this be needed?

    2. b.

      Do you often refer to this website?

    3. c.

      Is the information on the website accurate?

    4. d.

      Is there sufficient information on the website for your purposes?

  3. 3.

    Do you find the TGA medicines shortages website helpful?

    Prompts:

    1. a.

      In what way is it helpful/unhelpful?

    2. b.

      Can you provide some examples?

  4. 4.

    What do you believe could be done to improve or enhance the website?

  5. 5.

    If you do not believe it is a good intervention, what suggestions do you have about the issue of shortages and what can be done?

Thank the participant and ask if they wish for feedback in the form of a summary of findings.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, Y.X., Moles, R.J. & Chaar, B.B. Medicine shortages in Australia: causes, impact and management strategies in the community setting. Int J Clin Pharm 38, 1133–1141 (2016). https://doi.org/10.1007/s11096-016-0342-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-016-0342-1

Keywords

Search

Navigation