A Qualitative Study Exploring the Management of Medicine Shortages in the Community Pharmacy of Pakistan
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Setting
2.3. Interview Guide Development
2.4. Participant Enrollment
2.5. Qualitative Analysis
2.6. Reporting
2.7. Ethical Permission
3. Results
3.1. Theme 1: The Current Scenarios of Medicine Shortages in the Community Setting
3.2. Theme 2: Barriers Encountered during the Shortage Management
3.3. Theme 3: Impact of Medicine Shortages
3.4. Theme 4: Corrective Actions Performed for Handling Shortages
3.5. Theme 5: Future Interventions to Prevent Shortages
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Participants’ Recruitment | Number = (n) |
---|---|
Participants approached | 90 |
Participants selected based on the inclusion criteria | 51 |
Refused due to specific reason | 18 |
Agreed for participation | 33 |
Final participants at saturation | 31 |
Demographic | Interviewees |
---|---|
Sex (n, %) | |
Male | 25 (80.6) |
Female | 6 (19.3) |
Age (n, %) | |
20–30 | 11 (35.5) |
31–40 | 18 (58.1) |
>40 | 2 (6.4) |
Experience | 7.3 ± (3.8) |
Representative of community pharmacy type | |
Chain | 14 (45.2) |
Independent | 17 (54.8) |
Theme 1: The Current Scenarios of Medicine Shortages in the Community Setting | |
---|---|
Subtheme 1: Daily experience Subtheme 2: Panic buying, self medication and drug abuse are reasons for increasing shortages. Subtheme 3: Categorization of the short medicine Regularly short medicines Seasonally short medicines Shortages experienced in the COVID-19 pandemic | “I think the drug shortage is the situation in which our total supply of medicines is insufficient to meet the current or projected demand. I believe that shortage occurs every day in community setup of Pakistan” (CP11) “In my experience, the last year was much more difficult than the previous one, because we have the corona virus in the world beside this if we compare the last five years with the last year, so, we have multiple short medicines in only last year” (CP8) “The main drug which gets short is the Clonazepam comes under the brand name of Rivotril and Magura. All these brands are short from a couple of months and get short every year” (CP3) “We have shortage of antibiotics that is related to the upper respiratory tract infection specifically talking about in the winter season, as you know, the infection prevails in the winter season due to high smog and high fog level so, that medicine in the winter season is always got short from a distributor end” (CP1) “Last year there was a pandemic situation if we take an example; Azithromycin alternates were short and the Hydroxycloroquine tablet was too short, even the patients having arthritis couldn’t get it, just because of the pandemic situation” (CP6) |
Theme 2: Barriers Encountered during the Shortage Management | |
---|---|
Sub theme 1: Unethical activities
Subtheme 3:Physician prescribing behavior
| “Black marketing is the major offense which we see in a shortage situation. It should not be done”. (CP31) “In the shortage situation, some pharmacies do stockpiling when they get to know that some brands are becoming short in the market, they take bulk quantities. They hoard extra, not affective for the patient and not according to the demand of the patient”. (CP27) “Some distributors are biased for some re known chain pharmacies when they get stock of short medicine they don’t equally distribute their stock to the market”(CP3) “In Pakistan it is a common trend that the physician writes the brands not generics, so they have an edge to promote some brands and when we contact these physicians to write some other brands. They simply stick and refuse” (CP7). “The other barrier which we faced is the financial barrier, because we have to purchase other than our routine and we feel extra overload on ourselves” (CP29) |
Theme 3: Impact of Medicine Shortages | |
---|---|
Subtheme 1: Negative impact on the pharmacy reputation Subtheme 2: Hinderance in achieving the sale target Subtheme 3:Increase work load Subtheme 4:Lack of incentive to the working staff Subtheme 5:Distrubance in the relationship of pharmacy staff and patients | “Reputation hits so badly as customers perceived that we don’t have these medicines. So patients would not visit next time to purchase any type of medicine either it is present or not” (CP7) “Drug shortages definitely affected badly our routine operations, it increases workload and it takes a lot of energy in order to overcome such issues.” (CP28) “When customers get bounce due to the shortage of medicines so, we are unable to give incentives and any bonus to the working pharmacy staff”(CP8) “Patients don’t understand any logics and reasons, because they are totally in need of the drug that physicians have prescribed to them” (CP15) |
Theme 4: Corrective Actions Performed for Handling Shortages | |
---|---|
Subtheme 1: Proactive measures
| “Firstly we keep a sufficient stock of running items. The second practice we have is that we also keep a stock of these products which are not frequently in demand, but we keep it to avoid any rebound of customers”. (CP12) “We have to make relations with the distributions so that they can intimate us properly before any shortages of medicines we can purchase it prior to its shortage” (CP3) “When the medicine is short from the supplier end so either we have to suggest the alternate, or we can ask the patients to contact their doctors to change the medicine” (CP6) “If the patient doesn’t agree to take the alternative so, we then go towards the local purchase. Initially, we try to look for the surrounding pharmacies if they can avail the medicine for us” (CP4) “If we talk about the selling of short medicines, we try to sell it in a limited quantity to maximum customers. For example, if we sell one pack to one customer, in a shortage situation it’s better to sell three blisters to three customers so all people get benefit” (CP13) |
Theme 5: Future Interventions to Prevent the Shortages | |
---|---|
Subtheme 1: Proper monitoring on the medicine sale and consumption
Subtheme 3:Disseminating the information on shortages Subtheme 4:Need of the collaborative effort | “There should be strict actions taken by the regulatory authorities. And not without the recommendation of a doctor, if it’s written on the prescription the right patient will get the medicine” (CP6) “The distributor should distribute medicines first to the retailers and then when they have excess stock then they should deliver to the local market, but the priority should be the retailers”(CP3) “There must be a proper intimation from the supplier end before the medicine shortage. This reporting will be helpful as the medicine suddenly gets short and due to this shortage, we suffer a huge pressure from the consumers’ end because we don’t know the medicine re-availability” (CP7) “Everyone must fulfil their duties to overcome the medicine shortages, because it is not only pharmacist’s task. Purchasers to planners and suppliers to pharmacy managers, everyone is included in it” (CP21) |
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Omer, S.; Ali, S.; Shukar, S.; Gillani, A.H.; Fang, Y.; Yang, C. A Qualitative Study Exploring the Management of Medicine Shortages in the Community Pharmacy of Pakistan. Int. J. Environ. Res. Public Health 2021, 18, 10665. https://doi.org/10.3390/ijerph182010665
Omer S, Ali S, Shukar S, Gillani AH, Fang Y, Yang C. A Qualitative Study Exploring the Management of Medicine Shortages in the Community Pharmacy of Pakistan. International Journal of Environmental Research and Public Health. 2021; 18(20):10665. https://doi.org/10.3390/ijerph182010665
Chicago/Turabian StyleOmer, Sumaira, Salamat Ali, Sundus Shukar, Ali Hassan Gillani, Yu Fang, and Caijun Yang. 2021. "A Qualitative Study Exploring the Management of Medicine Shortages in the Community Pharmacy of Pakistan" International Journal of Environmental Research and Public Health 18, no. 20: 10665. https://doi.org/10.3390/ijerph182010665