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Table 2 Impact of medicines shortages on patients (overlapping theme)

From: What impact does medicines shortages have on patients? A qualitative study exploring patients’ experience and views of healthcare professionals

Themes

Subthemes

Categories

Supporting quotations

Impact of medicines shortages on patients

Clinical impact

Compromised treatment

• Delayed treatment

• Disease proliferation and complications

• Treatment failure

“Obviously, when patient fails to take medicine according to prescribed regimen, his disease proliferates and it could be difficult to control again. This is very evident in case of infectious diseases and cancer treatment. When good efficacy antibiotic brand is not available, recovering the patient becomes difficult.” (Physician 4)

“Sometimes efficacy of alternative generic as compared to international brand is less and that is unable to properly treat a disease.” (Pharmacist 1)

“It has huge impact on the patient. Patient suffers more than anyone else. I have experienced this in my skin allergy and the brand was not available due to shortage. Even cream and soap were not available. I was very worried because I wanted to recover quickly. Although, alternative brands were available, but I just wanted that specific brand. Because there was an ingredient in that brand, which was more effective for my skin.” (Patient 5)

 

Medication safety issues due to

• Wrong therapeutic alternative

• Medication error

• Adverse drug reactions

• Other risk associated with substandard and counterfeit medicines

“When any brand is short, we have to change it or sometimes, new brand has different strength or dosage form. As a result, the treatment regimen changes, but our patients are used to follow previous regimen and mostly have limited literacy level. In such case, risk of medication error increases and very often patient return and complain that they are having side effects.” (Physician 8)

“There are also few antihuman elements and when prescribed brand is not available, they take benefit from it and start selling substandard and counterfeit medicines. This happens especially with branded medicines because few brands have high demand. These counterfeit medicines are harmful and cause adverse drug reactions…” (Pharmacist 5)

“Alternative brands are mostly available but then there can be strength issues and it impacts patient a lot. I have blood pressure issue and I use Byscard 2.5 mg. Few days back, I don’t know it was short or dispenser was careless but he gave me 5 mg and he didn’t guide me to take half tablet. Due to which my blood pressure got very low, which was not good impact. I could have died.” (Patient 4)

 

Risk of mortality

“In hospitals, there are many patients who cannot afford a single penny over medicines, so ultimately, when they cannot get medicines from hospitals, their condition gets worsen and worsen or some may lead to death as well.” (Physician 4)

“If any generic gets short then obviously all those patients who are taking that generic, for example asthma patients have to take inhalers, TB patients have to be on ATT so their whole treatment will be disturbed, even this could be fatal…” (Pharmacist 6)

“Sometimes, it turns into a matter of life and death. My father is heart patient and you know anti-angina medicine is very much important for such patients. But it was critically short in the market. I am pharmaceutical distributor but it was difficult even for me to find it. You can understand the consequences if such important medicines are short...” (Patient 7)

Humanistic impact

• Confusion

• Wastage of time

“Comparable efficacy brands are available in markets, but as most of the people are illiterate, they are not aware of it. If the physician prescribes him a brand which is not available in the market, he will be confused and faced with a problem in search of that brand. Patients waste time and ask for same medicine brand again and again, because they want that specific medicine brand.” (Physician 11)

“Patient experiences a lot of confusion when prescribed brand is not available in the market. If a pharmacist advises patient on some alternative brand, he usually hesitates to take his advice and proceed to search for the particular brand.” (Pharmacist 5)

“If there is a shortage of branded medicine then we have to visit other pharmacies. It takes a lot of time. In case alternative is available, we have the satisfaction issue that whether the alternative will be good or not, we will recover or not. We feel the need to visit the physician again to confirm.” (Patient 8)

Financial burden

• Increased treatment costs

• Patient out-of-pocket costs

“If we give alternative and that alternate is costly then it effects on the pocket of the patient.” (Pharmacist 13)

“In case of shortage, patients buy medicines from drug retail outlets. But usually, patients who visit government hospitals are not rich and they only come in search of free medication. When any medicine is not available in the hospital, we ask them to buy it from outside and this increases burden on patients.” (Physician 9)

“It takes a considerable amount of time and money. Sometimes, we have to purchase high price alternative brand or the same brand at high price from black marketers.” (Patient 8)