promoting patient-centred healthcare around the world
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Promoting patient-centred healthcare around the world. Drug Shortages and Patient Impact. Suzanne Nurse, PhD Co-Chair, Canadian Epilepsy Alliance Drug Shortages Committee Independent Member, Best Medicines Coalition. International Summit on Medicines Shortage - PowerPoint PPT PresentationTRANSCRIPT
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Promoting patient-centred healthcare around the world
Drug Shortages and Patient Impact
International Summit on Medicines ShortageToronto, Ontario, Canada 20-21 June 2013
Suzanne Nurse, PhDCo-Chair, Canadian Epilepsy Alliance Drug Shortages Committee
Independent Member, Best Medicines Coalition
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Patient-Centred Care: Framework for Ethical Healthcare
Drug Shortages & Patient Impact
1. The Problem2. Public Awareness3. The Cause?4. Need for Transparency5. Importance of FIP Forum6. Patient Engagement
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Patient-Centred Care: Framework for Ethical Healthcare
The Problem
50% Actual Shortage
30% Near Miss
20% No Shortage
Respondent Experience with Drug Shortages:
Drug shortages are a global problem from Afghanistan to Zimbabwe
Source: WHO, 2012
Source: JAMA, 2013
55% of Canadian pharmacists reported “drug shortages had a “significant” impact on patient care and outcomes”
Source: CPhA, 2013
Source: ISPE, 2013
Patient-Centred Care: Framework for Ethical Healthcare
Risk of a Catastrophic Drug Shortage
• If this risk were a virus, we would be issuing public health warnings and desperately seeking a vaccine;
• If this threat were looming storms, we would have evacuated residents along coastal areas;
• If pending shortages were of beer this summer, every bar would have a contingency supplier…
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Patient-Centred Care: Framework for Ethical Healthcare
Instead, it’s just shortages of essential medicines for cancer, epilepsy, infections, pain, surgery and other serious conditions. (So we’re hoping it won’t happen again, or if it does, the impact will be minimal).
Patient-Centred Care: Framework for Ethical Healthcare
Why Hasn’t the Public Been Informed?How many patients even know about drug shortages until they are …
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Like Brian, who can’t get his prescription refilled at the pharmacist. And is then given three days’ supply followed by two weeks of medication and told to “cut it in half” because it’s the wrong dosage?
Like Jeff, who was told his daughter would need to delay the start of chemotherapy because the drug wasn’t available, and that there were other patients with priority?
Patient-Centred Care: Framework for Ethical Healthcare
And, of course, the public is mostly unaware about the shortages responsible for cancelled surgeries, reduced doses of pain medication, or delayed treatment of infectious conditions.
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Like Emily, who was suddenly told to purchase her anti-nausea medication at the local pharmacy because it was not going to available at the cancer clinic along with her chemotherapy?
Like Jessica who, in order to avoid switching her daughter’s epilepsy medication, counts herself lucky because she can “slip across the border” to get the prescription filled in a pharmacy in another country?
Patient-Centred Care: Framework for Ethical Healthcare
Lack of Investigation re: Causes of Shortages• Why are drug shortages most acute in
countries like USA, Canada, and Australia?• Why is there less impact in Europe?• How are shortages affecting emerging
economies? • Should patients expect shortages to continue?• Where and to what degree are shortages likely
to occur in the future?• Why hasn’t there been a systematic
investigation as to the causes… so we can eliminate the shortages?
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?
Patient-Centred Care: Framework for Ethical Healthcare
Consequences of Lack of Transparency
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• Allows lack of action and perpetuates drug shortages;
• Patients only learn when they cannot get drugs needed;
• Not informing patients has consequences (unwilling to accept substitutions, no contingency plans);
• Patients, once the victim of a shortage, live in constant fear;
• Patients are kept out of problem-solving and finding solutions
Patient-Centred Care: Framework for Ethical Healthcare
Climate of suspicion and distrustWith a lack of “good information” and lack of transparency
theories and rumours grow:
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Is “lack of supply” deliberate on part of manufacturers to switch patients to more costly products?
Is the health system substituting “lower quality” foreign products for domestic supplies?
Are internet pharmacies usurping drugs that should be available to residents?
Has “bulk purchasing” and competitive pricing led to over-reliance on limited number of “low-cost” suppliers?
Are generic prices too low and therefore there is no incentive to supply?
Patient-Centred Care: Framework for Ethical Healthcare
Importance of FIP Forum in Canada
• Drug shortages have been a chronic problem for a number of years and acute in the last 2-3 years
• No sense that the problem has been resolved or even understood as to its causes, so patients remain at risk
• Canada, like many public health systems, is less than transparent and loathe to deal with safety issues until there is serious harm and a public spotlight
• A conference like this should be open to all patients and public
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Patient-Centred Care: Framework for Ethical Healthcare
Drug Shortages Impact Individuals
People need access to a consistent supply of medication.
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Promoting patient-centred healthcare around the world
Patient-Centred Care Requires Patient Engagement at All Levels
Durhane Wong-Rieger, PhDChair, International Alliance of Patients’ Organizations