Patients Perspectives on Medicines Shortages in Hospital Setting

  • Darija Kuruc PojeEmail author
Part of the Lecture Notes in Logistics book series (LNLO)


Medicine shortages represent serious problem for the healthcare system leading to interference with patient care. Studies are mainly done in the USA and Canada which reported more side effects and longer hospitalization. In Europe research is mainly focused on opinions from stakeholders, community and hospital pharmacists and rarely on clinical impact or opinions from patients. Two of the biggest pan-European studies regarding medicine shortages impact on hospital pharmacists were done by European Association of Hospital Pharmacists (EAHP) in 2014 and in 2018. They have found an increase in medicine shortages from 2014 to 2018. While in 2014, 86% in 2018 92% of hospital pharmacists reported that they had current problems with medicine shortages in terms of delivering the best care to patients and/or operating the hospital pharmacy. The most affected therapeutic areas were: infectious diseases, oncology, emergency medicine, cardiovascular medicine and anesthesia. It also reported negative impacts for patients which include: delayed care, cancellations of care, medication errors, suboptimal treatment/inferior efficacy, unnecessary experience by patients of side effects, deterioration in patients’ conditions and even death. Furthermore, patients’ perspectives on medicines shortages in hospital setting have not been well documented in the literature. Therefore, a qualitative study is ongoing in several European countries (Croatia, Serbia, Portugal, Bosnia and Herzegovina, Germany, Greece, etc.) with the purpose of quantifying the effect of medicine shortages on patient outcomes. This study will help to be more acquainted with the patients’ complaints, wishes and needs. In addition, it will fill informational gaps from previous surveys regarding patients’ perspectives as well as gather contemporary data regarding these patient care issues.



I would like to acknowledge COST Action CA15105 European Medicines Shortages Research Network—addressing supply problems to patients (Medicines Shortages), Prof. Helena Jenzer—BFH Bern University of Applied Sciences, Dr. Roberto Frontini—Universitatklinikum Leipzig, Prof. Isabelle Huys—Clinical Pharmacology and Pharmacotherapy KU Leueven, Elfi de Weerdt, and Working Group Leader Dr. Nenad Miljković—M.Pharm., MPH, Institute of Orthopaedic Surgery “Banjica”, Serbia. Prof. João Luís de Miranda, Departamento de Tecnologias, Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Portalegre, Portalegre, Portugal.


  1. Becker, D. J., Talwar, S., Levy, B. P., Thorn, M., Roitman, J., Blum, R. H., et al. (2013). Impact of oncology drug shortages on patient therapy: Unplanned treatment changes. Journal of Oncology Practice, 9(4), e122–e128.CrossRefGoogle Scholar
  2. Bible, J. R., Evans, D. C., Payne, B., & Mostafavifar, L. (2014). Impact of drug shortages on patients receiving parenteral nutrition after laparotomy. Journal of Parenteral and Enteral Nutrition, 38(suppl 2), 65S–71S.CrossRefGoogle Scholar
  3. Bogaert, P., Bochenek, T., Prokop, A., & Pilc, A. (2015). A qualitative approach to a better understanding of the problems underlying drug shortages, as viewed from Belgian, French and the European Union’s Perspectives. PLoS ONE, 10(5), e0125691.CrossRefGoogle Scholar
  4. Canadian Drug Shortage. (2018). Canadian drug shortage. Possible Causes of the Drug Shortage. Retrieved May 15, 2018, from
  5. Canadian Pharmacists Association. (2010). Canadian drug shortages survey: Final report. Ottawa: Canadian Pharmacists Association.Google Scholar
  6. Casassus, B. (2015). Europe urged to take action on drug shortages. The Lancet, 385(9975), 1279–1280.CrossRefGoogle Scholar
  7. De Weerdt, E., Pauwels, K., Simoens, S., & Huys, I. (2015). Belgian experiences with drug shortages. HPE.Google Scholar
  8. De Weerdt, E., Simoens, S., Casteels, M., & Huys, I. (2017). Clinical, economic and policy implications of drug shortages in the European Union. Applied Health Economics and Health Policy, 15(4), 441–445.CrossRefGoogle Scholar
  9. Dranitsaris, G., Jacobs, I., Kirchhoff, C., Popovian, R., & Shane, L. G. (2017). Drug tendering: Drug supply and shortage implications for the uptake of biosimilars. Clinicoeconomics & Outcomes Research, 9, 573–584.CrossRefGoogle Scholar
  10. EAHP. (2018). 2018 Medicines Shortage Survey. EAHP’s 2018 Survey on Medicines Shortages to improve patient outcomes. Retrieved November 21, 2018, from
  11. EAHP. (2014). EAHP’s 2014 survey of the medicines shortage problem. Retrieved October 5, 2018, from
  12. Fox, E. R., Sweet, B. V., & Jensen, V. (2014). Drug shortages: A complex health care crisis. Mayo Clinic Proceedings, 89(3), 361–373.CrossRefGoogle Scholar
  13. Gatesman, M. L., & Smith, T. J. (2011). The shortage of essential chemotherapy drugs in the United States. New England Journal of Medicine, 365(18), 1653–1655.CrossRefGoogle Scholar
  14. Gundlapalli, A. V., Beekmann, S. E., Graham, D. R., Polgreen, P. M., & Members of the Emerging Infections Network. (2018). Antimicrobial agent shortages: The new norm for infectious diseases physicians. Open Forum Infectious Diseases, 5(4), ofy068.Google Scholar
  15. Gupta, D. K., & Huang, S. M. (2013). Drug shortages in the United States: A critical evaluation of root causes and the need for action. Clinical Pharmacology and Therapeutics, 93(2), 133–135.CrossRefGoogle Scholar
  16. Hawley, K. L., Mazer-Amirshahi, M., Zocchi, M. S., Fox, E. R., & Pines, J. M. (2016). Longitudinal trends in U.S. drug shortages for medications used in emergency departments (2001–2014). Academic Emergency Medicine, 23(1), 63–69.Google Scholar
  17. Hsia, I. K., Dexter, F., Logvinov, I., Tankosic, N., Ramakrishna, H., & Brull, S. J. (2015). Survey of the national drug shortage effect on anesthesia and patient safety: A patient perspective. Anesthesia and Analgesia, 121(2), 502–506.CrossRefGoogle Scholar
  18. Institute For Safe Medication Practices (ISMP). (2017). ISMP survey on drug shortages for hospital pharmacy directors or their designees only. ISMP Medication Safety Alert!, 22(17), 5–6.Google Scholar
  19. International Pharmaceutical Federation. (2011). Medicines shortages. FIP addressing global medicines shortages. Retrieved May 12, 2018, from
  20. International Pharmaceutical Federation. (2013). Report of the international summit on medicines shortage. Hague, Netherlands: International Pharmaceutical Federation.Google Scholar
  21. Kaakeh, R., Sweet, B. V., Reilly, C., Bush, C., DeLoach, S., Higgins, B., et al. (2011). Impact of drug shortages on U.S. health systems. American Journal of Health-System Pharmacy, 68(19), 1811–1819.Google Scholar
  22. Lukmanji, S., Sauro, K. M., Josephson, C. B., Altura, K. C., Wiebe, S., & Jetté, N. (2017). A longitudinal cohort study on the impact of the clobazam shortage on patients with epilepsy. Epilepsia, 59(2), 468–478.CrossRefGoogle Scholar
  23. Mazer-Amirshahi, M., & Fox, E. R. (2018). Saline shortages—Many causes, no simple solution. New England Journal of Medicine, 378(16), 1472–1474.CrossRefGoogle Scholar
  24. Mazer-Amirshahi, M., Goyal, M., Umar, S. A., Fox, E. R., Zocchi, M., Hawley, K. L., et al. (2017). U.S. drug shortages for medications used in adult critical care (2001–2016). Journal of Critical Care, 41, 283–288.CrossRefGoogle Scholar
  25. McBride, A., Holle, L. M., Westendorf, C., Sidebottom, M., Griffith, N., Muller, R. J., et al. (2013). National survey on the effect of oncology drug shortages on cancer care. American Journal of Health System Pharmacy, 70, 609–617.CrossRefGoogle Scholar
  26. McLaughlin, M., Kotis, D., Thomson, K., Harrison, M., Fennessy, G., Postelnick, M., et al. (2013). Effects on patient care caused by drug shortages: A survey. Journal of Managed Care Pharmacy, 19(9), 783–788.CrossRefGoogle Scholar
  27. Patiño, A. M., Marsh, R. H., Nilles, E. J., Baugh, C. W., Rouhani, S. A., & Kayden, S. (2018). Facing the shortage of IV fluids—A hospital-based oral rehydration strategy. New England Journal of Medicine, 378(16), 1475–1477.CrossRefGoogle Scholar
  28. Pauwels, K., Simoens, S., Casteels, M., & Huys, I. (2015). Insights into European drug shortages: A survey of hospital pharmacists. PLoS ONE, 10, e0119322.CrossRefGoogle Scholar
  29. Reed, B. N., Fox, E. R., Konig, M., Jackevicius, C. A., Masoudi, F. A., & Rabinstein, A. A. (2016). The impact of drug shortages on patients with cardiovascular disease: Causes, consequences, and a call to action. American Heart Journal, 175, 130–141.CrossRefGoogle Scholar
  30. Rinaldi, F., de Denus, S., Nguyen, A., Nattel, S., & Bussières, J. F. (2017). Drug shortages: Patients and health care providers are all drawing the short straw. Canadian Journal of Cardiology, 33(2), 283–286.CrossRefGoogle Scholar
  31. Schweitzer, S. O. (2013). How the US Food and Drug Administration can solve the prescription drug shortage problem. American Journal of Public Health, 103(5), e10–e14.CrossRefGoogle Scholar
  32. Smid, B. E., Rombach, S. M., Aerts, J. M. F. G., Kuiper, S., Mirzaian, M., Overkleeft, H. S., et al. (2011). Consequences of a global enzyme shortage of agalsidase beta in adult Dutch Fabry patients. Orphanet Journal of Rare Diseases, 1(6), 69.CrossRefGoogle Scholar
  33. US Department of Health and Human Services, Food and Drug Administration. (2011). A review of FDA’s approach to medical product shortages. Silver Spring, USA: US Department of Health and Human Services, Food and Drug Administration.Google Scholar
  34. Vail, E., Gershengorn, H. B., Hua, M., Walkey, A. J., Rubenfeld, G., & Wunsch, H. (2017). Association between US norepinephrine shortage and mortality among patients with septic shock. JAMA, 317(14), 1433–1442.CrossRefGoogle Scholar
  35. Ventola, C. L. (2011). The drug shortage crisis in the United States: Causes, impact, and management strategies. Pharmacy and Therapeutics, 26(11), 740–757.Google Scholar
  36. WHO. (2015). Technical consultation on preventing and managing global stock outs of medicines. Retrieved October 5, 2018, from
  37. Woodcock, J., & Wosinska, M. (2013). Economic and technological drivers of generic sterile injectable drug shortages. Clinical Pharmacology and Therapeutics, 93(2), 170–176.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Hospital Pharmacy DepartmentGeneral Hospital “Dr. Tomislav Bardek” KoprivnicaKoprivnicaCroatia

Personalised recommendations