Drug shortages across the United States are taking a measurable toll on patient care and physician workflow, according to a recent survey of 902 primary care physicians published in JAMA Network Open.
Roughly one in five patients have been affected, with the highest impact seen in medications for endocrinology, stimulants, infectious disease, pulmonology and pain management, the survey found. Pediatricians reported particularly high impacts for infectious disease, pulmonology and stimulant drugs.
Nearly all affected patients discontinued the specific medication, leading to 57 % experiencing minor adverse events. About half of physicians indicated their patients experienced disease progression, and a similar percentage reported their patients sought medications through compounding pharmacies or by traveling abroad. One-third of patients substituted alternative drugs, and one-quarter consulted non-physician practitioners. Major adverse events (13%) and death (2%) were less prevalent but still notable impacts of drug shortages.
See also: What will it take to keep pharmacy benefits sustainable amid rising drug costs?
Physicians responded to drug shortages by changing the drug of choice far more often than by postponing prescriptions—92% adjusted medications, while 63% delayed prescribing. Pediatricians, however, were less likely than other specialties to hold off on treatment. When selecting alternatives, physicians weighed multiple factors, including drug efficacy (89%), potential adverse effects (81%), out-of-pocket costs for patients (78%), prior authorization requirements (73%) and the method of administration (58%). Many also faced challenges such as limited or unavailable substitutes (44%), the need to combine multiple medications to replace one (30%) and the risk of dispensing errors (11%).
Physicians were most often notified of shortages by patients or community pharmacists, highlighting gaps in communication channels. Many relied on electronic health record alerts when prescriptions were not filled, which limited their ability to explore alternatives and may have contributed to patient discontinuation or riskier care-seeking behavior. Administrative burdens were significant and include prior authorizations, overtime, frustration and burnout. Physicians required a median of 0.5 full-time staff equivalents to manage the added workload caused by drug shortages, according to the report.
Experts cite concentrated manufacturing, small profit margins, regulatory burdens, natural disasters and rising demand as the driving forces behind the ongoing shortage crisis.
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