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(Reuters Health) – More than two-thirds of US hospital pharmacists face at least 50 drug shortages a year, according to a new study suggesting that hospital staff are often forced to ration life-saving medications.
The researchers surveyed 719 pharmacists in the country's large and small hospitals in 2018. Each of them reported at least one drug shortage in the last year and 69% had at least 50 shortages. during this period.
Most often, pharmacists said they had less than a month of warnings about declining stocks before having to deal with a shortage of drugs, reported the team. study in JAMA Internal Medicine.
Four out of five pharmacists reported having ambaded rare drugs. One in three said the hospital had to ration drugs and refuse medicine to at least some patients who needed it.
"Patients are generally not informed when this happens," said Dr. Andrew Hantel, senior author of the University of Chicago.
"These are issues that have a direct impact on patients and they need to be aware that they exist and occur all over the United States," Hantel said via email.
One in three pharmacists said his hospital did not have any valid administrative mechanism to help him deal with a shortage.
The study also revealed that in about half of the cases, doctors or treatment teams alone took the decision to allocate the rationed drugs.
Although most other rationing decisions were made by committees, only 5% of committees included medical ethicists to help guide the use of rare drugs.
Rationing was more common in university hospitals and their affiliates than in community hospitals.
Many medications involved in hospital shortages are injected or infused medications intended to relieve pain, treat common health problems such as cancer and heart disease, and fight infections.
Currently, 226 drugs are rare, according to a list established by the American Society for Hospital Pharmacists. Current shortages include anti-cancer drugs, vaccines and heart medications.
The study was not designed to determine if shortages have a direct impact on patient outcomes. According to the authors of the study, it is also possible that shortages in hospitals differ from the drug supply problems that people usually take at home. Nor have the researchers examined the causes of drug shortages.
"Shortages can occur for many reasons, including disruptions in the supply chain, the departure of manufacturers from the market and even natural disasters," said Dr. Aaron Kesselheim, a researcher at Brigham and Women & # 39; s Hospital and Harvard Medical School in Boston. l & # 39; study.
"When Hurricane Maria, for example, tragically hit Puerto Rico, a lot of the US saline supply was affected because a lot of it was made there," Kesselheim said by e-mail.
"Policymakers should consider whether a back-up system is needed to ensure that the commodities of inpatient health care delivery remain available," Kesselheim added. "Substitutes may not be available in all cases, and we conducted a study showing that in the event of a shortage of a product, we found that substitutes manufacturers were reacting by apparently raising their prices. "
Patients are often in the dark, said Stacie Dusetzina, a health policy researcher at the Vanderbilt University School of Medicine in Nashville, Tennessee, who was not involved in the study.
"In cases where there is a clear surrogate, there can be no impact on patients," Dusetzina said via e-mail. "However, knowing that you can not get the medication that your doctor is asking you to take and that there is no substitute available could be very painful and have an impact on the patient's health. "
SOURCE: bit.ly/2CDGPq4 JAMA Internal Medicine, online March 25, 2019.
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