The Prevalence And Patient Perception Of Medicine Shortages In A State Sector Hospital In Sri Lanka

• By: DILSHA, Nimmi (Queensland University of Technology, Australia, Australia)
• Co-author(s): Ms Nimmi Dilsha (Queensland University of Technology, Brisbane, Australia)
  Dr Esther Lau (Queensland University of Technology, Brisbane, Australia)
  Dr. Thushara Matthias (University of Sri Jayewardenepura, Nugegoda, Sri Lanka)
  Dr. Ayda Sefidaniforough (Queensland University of Technology, Brisbane, Australia)
  Dr Marea Patounas (Queensland University of Technology, Brisbane, Australia)
  Prof. Rohini Fernandopulle (General Sri John Kotelawala Defense University, Rathmalana, Sri Lanka)
  Prof Lisa Nissen (University of Queensland, Brisbane, Australia)
  
• Abstract:

  Background: Medicine shortages are a global issue and are underrepresented in developing countries such as Sri Lanka, where monitoring the prevalence of medicines shortages and their impact is difficult, due to the absence of medicine shortage reporting and notification systems. As the priority healthcare service provider, identification of the prevalence and patient perception of medicine shortages in the State sector is an essential initial step to be employed in managing medicine shortages in Sri Lanka.
  
  Purpose: The purpose of this study was to identify the prevalence and patient perception of medicine shortages in a Sri Lankan State hospital.
  
  Method: In the first quarter of the year 2023, a quantitative study with two parts was conducted at the outpatient pharmacy of the medical clinic in a tertiary care hospital in Sri Lanka. In Part 1, patients (n=392) with a minimum of two previous clinic visits were invited to participate after having their prescriptions dispensed. To determine the prevalence of medicines shortages in the hospital, participants’ prescriptions were assessed, and the short supply of medicines to patients was noted e.g. medicines marked as out-of-stock on patient prescriptions by the pharmacists, and the substitution of prescribed brands or strengths in medicine shortages. Patients who experienced medicines shortages in Part 1 were invited to participate in a verbally administered structured survey (Part 2), which explored their knowledge, experiences (in the pre and post-COVID-19 pandemic era), and preferences regarding information on medicine shortages.
  
  Results: The majority of the participants were aged above 60 years, females, with ischemic heart diseases, and a monthly income of less than 10,000 Sri Lankan Rupees. Medicines were short-supplied to most of the participants, namely because the medicine was out-of-stock, followed by limited quantities of the medicine being available in the hospital system. Some medicines were completely out-of-stock and unavailable e.g. furosemide tablets, losartan potassium tablets, enalapril maleate tablets, salbutamol metered-dose inhaler capsules and biphasic human insulin injections. Other medicines had to be substituted for a different strength e.g. atorvastatin tablets, metformin tablets and gliclazide tablets. In these instances, dosage instructions were amended e.g. patients were asked to break tablets, and take one-quarter or eight tablets of the available strength, to administer the equivalent of their usual dose.
  Most of the participants completed the part 2 survey. Medicine shortages in the clinic visits impacted patients clinically, economically and ethically; and medicine shortages were experienced more frequently after the COVID-19 pandemic. Among respondents, the majority reported pharmacists to be their first source of information about medicines shortages. Despite the lack of understanding about medicine shortages, most of the participants were not interested in more information on medicine shortages.
  
  Conclusion: Multiple essential medicines are in shortage in the Sri Lankan State Hospital system which impacts clinically, economically, and ethically to patients. Monitoring the prevalence of medicine shortages, risk assessment of medicine shortages and related substitutions and patient education on medicine shortages is required in managing medicine shortages in Sri Lanka.
  
  Keywords: Medicine shortages, medicine stock-outs, prevalence, patient perceptions, Sri Lanka