Malta tops the list as the country which is affected the most by medicine shortages on a daily basis, according to the largest pan-European survey on medicine supply shortages.

According to the European Association of Hospital Pharmacists (EAHP), 72.7 per cent of hospital pharmacists in Malta said they experience a shortage of a medicine every day. Medicine shortages in Malta typically last for “weeks”.

Doses are missed, treatments are switched to less efficacious alternatives, and medical errors are caused as a result

Most hospital pharmacists from the 36 European countries surveyed responded that they are affected by shortages on a weekly rather than a daily basis. The survey, conducted between March and May, contrasts sharply with figures given in the 2015 Budget last night, where the number of out-of-stock medicines was said to have gone down drastically.

Often, hospital pharmacists are only aware of a shortage when they are first unable to obtain a medicine, the survey notes.

“They are not made aware of a shortage in advance, and this makes planning and coordinating supply impossible. Additionally they have no certainty about when a medicine may become available again. This is a source of frustration and puts the hospital pharmacist in a helpless situation.”

A hospital pharmacist in Malta was asked the question “What is the longest duration that you can recall a medicine being in shortage for?” The response was that halothane (inhaled anaesthetic) was unavailable for between two and three years.

Malta was also among the countries which lost the most time in tracking down medicines to meet a patient’s needs due to drug shortages.

Replying to a question on how much time (staff working time) in an average week was lost over drug shortage problems, hospital pharmacists in Malta estimated over 15 hours. “More than 15 hours – not personally but as a pharmacy department in general, 1.5 FTE [full time equivalent] pharmacists work solely on chasing out-of-stock items,” a hospital pharmacist in Malta is quoted as saying.

According to EAHP president Roberto Frontini, the impact of out-of-stock medicines is not just an organisational headache for the pharmacy – but the detrimental impact to patients is “very real”.

“Doses are missed, treatments are switched to less efficacious alternatives, and medical errors are caused as a result. Add the extra stress in a safety-critical environment, the loss of man hours and the gross distraction shortages cause to the provision of other pharmacy services, and you have a pan-European public health threat requiring action at the EU level.”

Malta is also the country reporting the highest prevalence of shortages in cardiovascular medicines.

Across Europe, hospital pharmacies obtain their medicines from a variety of sources, including the pharmaceutical industry, wholesalers, “specials” companies, other hospitals and their own production.

Malta reports that 89 per cent of its medicines are obtained from wholesalers, with the remaining 11 per cent from “specials”.

Supply directly from the pharmaceutical industry is more common in northeastern Europe, while in the southwest supply is more common from wholesalers.

Possible reasons for this could include the concentration of the pharmaceutical industry in western Europe and pricing structures in eastern Europe which favour wholesale supply.

Participants were asked to suggest policy options which could be implemented to tackle the medicine shortage problem.

The two most popular options were having more legal clarity on the responsibility of manufacturers to openly report disruption and having a comprehensive database, run by the European Medicines Agency, of all medicines reported to be in current shortage in at least five EU member states.

Pharmacists have a say:

“I work as a clinical pharmacist in the gastroenterology department. In the past year, mesalazine rectal preparations have always been problematic, causing a lot of undue hassle to patients and also to staff.”

“There were delays in treating patients or having to maintain a patient on intravenous treatment just because the oral alternative was not available. In addition, patients who get their out-patient treatment from an NHS pharmacy sometimes require hospital admission because they are not available.”

“Bumetanide tablets and spirinolactone (diuretics used in cardiology) were out of stock, leading to patients being admitted with oedema and exacerbation of heart failure. Also a ketoconazole shortage has led to a patient readmitted with Cushing’s symptoms.”

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