International Journal of Clinical Pharmacy

, Volume 38, Issue 5, pp 1133–1141 | Cite as

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

  • Yee Xi Tan
  • Rebekah J. Moles
  • Betty B. ChaarEmail author
Research Article


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.


Australia Community pharmacy Health care professional perspective Medicine shortages Patient impact TGA website 




Conflicts of interest



  1. 1.
    Talsma J. Drug shortages still at crisis levels. Drug Top. 2013;157(6):32.Google Scholar
  2. 2.
    Boyle K. Drug shortages: Canadian strategies for a complex global problem. Health Manage Forum. 2012;25:S48–58.CrossRefGoogle Scholar
  3. 3.
    Johnson PJ. The ongoing drug shortage problem affecting the NICU. Neonatal Netw. 2012;31:323–7.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.PubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 7.
    Fox ER, Sweet BV, Jensen V. Drug shortages: a complex health care crisis. Mayo Clin Proc. 2014;89:361–73.CrossRefPubMedGoogle Scholar
  8. 8.
    Gatesman ML, Smith TJ. The shortage of essential chemotherapy drugs in the United States. N Engl J Med. 2011;365:1653–5.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 12.
    Gagnon MA. Drug shortages: searching for a cure. Healthc Policy. 2012;7(4):10–7.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Huys I, Simoens S. Editorial: European drug shortages: a call for action! Int J Pharm Pract. 2013;21:1–2.CrossRefPubMedGoogle Scholar
  14. 14.
    Quilty S. Medicines shortages in Australia—the reality. Australas Med J. 2014;7(6):240–2.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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. 16.
    US Food and Drug Administration. [Internet]. Current drug shortages; 2015. [Cited 26 Oct 2015].
  17. 17.
    American Society of Health-System Pharmacists. [Internet]. Drug Shortages: Current Shortages; 2015. [Cited 2015 Oct 26].
  18. 18.
    Chaar BB. Medicine shortages: Implications for the Australian healthcare system. Australas Med J. 2014;7(3):161–3.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Australian Government. [Internet]. Department of Health Therapeutic Goods Administration; 2015. [Cited 2015 Oct 26].
  20. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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. 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.CrossRefGoogle Scholar
  23. 23.
    Australian Institute of Health and Welfare. [Internet]. Admitted patient care 2013–2014: Australian hospital statistics; 2015. [Cited 2015 Oct 26].
  24. 24.
    The Pharmacy Guild of Australia. [Internet]. Serving Australians: a system of community pharmacy; 2012. [Cited 2015 Oct 26].
  25. 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.CrossRefGoogle Scholar
  26. 26.
    Clarke PM. Challenges and opportunities for the Pharmaceutical Benefits Scheme. Med J Aust. 2012;196:153–4.CrossRefPubMedGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. 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. 33.
    Pauwels K, Simoens S, Casteels M, Huys I. Insights in European drug shortages: a survey of hospital pharmacists. Value Health. 2014;17:A14.CrossRefGoogle Scholar
  34. 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.PubMedPubMedCentralGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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.CrossRefPubMedGoogle Scholar
  37. 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.PubMedPubMedCentralGoogle Scholar
  38. 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.CrossRefGoogle Scholar
  39. 39.
    Golembiewski J. Drug shortages in the perioperative setting: causes, impact, and strategies. J Perianesth Nurs. 2012;27:286–92.CrossRefPubMedGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 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.CrossRefGoogle Scholar
  42. 42.
    Weaver JM. Why are there so many drug shortages? Anesth Prog. 2010;57:89–90.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 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. 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. 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.CrossRefPubMedGoogle Scholar
  46. 46.
    American Society of Health-System Pharmacists. [Internet]. current shortages: chloroquine tablets; 2015. [Cited 2015 Oct 26].
  47. 47.
    US Food and Drug Administration. [Internet]. Current drug shortages: chloroquine phosphate tablets; 2015. [Cited 2015 Oct 31]. Phosphate Tablets&st = c&tab = tabs-1.

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Yee Xi Tan
    • 1
  • Rebekah J. Moles
    • 1
  • Betty B. Chaar
    • 1
    Email author
  1. 1.Faculty of PharmacyThe University of SydneySydneyAustralia

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