Hospital Pharmacists forced to Ration Drugs Due To Drug Shortages

By Lisa Rapaport, for Reuters Health.

Hospital medication shortages are forcing clinicians to decide which patients receive needed medications and which do not.

More than two-thirds of pharmacists in U.S. hospitals deal with at least 50 drug shortages every year, according to a new study that suggests hospital staff are often forced to ration life-saving medicines as a result.

Researchers surveyed 719 pharmacists at large and small hospitals across the country in 2018. Every one of them reported experiencing at least one drug shortage in the past year, and 69 percent had dealt with at least 50 shortages in that time.

Most often, pharmacists said they had less than a month of warning about dwindling supplies before they had to manage an active drug shortage, the study team reports in JAMA Internal Medicine.

Four in five pharmacists said they hoarded scarce medicines. One in three said the hospital had to ration drugs and deny medicines to at least some patients who needed them.

“Patients are not commonly told when this occurs,” said lead author Dr. Andrew Hantel of the University of Chicago.

“These are issues that directly impact patients and they should be aware that they exist and occur throughout the United States,” Hantel said by email.

One in three pharmacists said their hospital had no valid administrative mechanism to help them respond to a shortage.

Roughly half the time, individual doctors or treatment teams made decisions on their own about how to allocate drugs being rationed, the study also found.

While most of the rest of the rationing decisions were made by committees, only 5 percent of committees included medical ethicists to help guide the use of scarce medicines.

Rationing was more common at academic hospitals and their affiliates than at community hospitals.

Many drugs involved in hospital shortages are injected or infused medicines for pain relief, treating common health problems like cancer and heart conditions, and fighting infections.

Presently, 226 medicines are in short supply, according to a running list kept by the American Society for Hospital Pharmacists. Current shortages include cancer drugs, vaccines and heart medicines.

The study wasn’t designed to look at whether shortages directly impact patient outcomes. It’s also possible that shortages in hospitals might differ from supply problems for drugs people commonly take at home, the study authors note. Researchers also didn’t examine the causes of drug shortages.

“Shortages can happen for many reasons, including disruptions in the supply chain, manufacturers leaving the market and even natural disasters,” said Dr. Aaron Kesselheim, a researcher at Brigham and Women’s Hospital and Harvard Medical School in Boston who wasn’t involved in the study.

“When Hurricane Maria, for example, tragically struck Puerto Rico, much of the U.S. supply of normal saline was affected because much of it was manufactured there,” Kesselheim said by email.

“Policymakers should take up the question of whether a back-up system is needed to ensure that basic staples of inpatient healthcare delivery remain available,” Kesselheim added. “Substitutes may not be available in all cases, and we conducted a study showing that in the case of a shortage of one product, we found that manufacturers of substitutes responded by apparently raising their prices.”

Patients are often in the dark, said Stacie Dusetzina, a health policy researcher at Vanderbilt University School of Medicine in Nashville, Tennessee, who wasn’t involved in the study.

“In cases where there is a clear substitute, then there may be no impact on patients,” Dusetzina said by email. “However, knowing that you cannot obtain a drug that your doctor wants you to take and that there are no substitutes available could be highly distressing and could impact patient health.”

March 29, 2019

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