Medication Supply Chain Research Articles

Blockchain-Based Secured Drug Traceability in Health Care Application

Despite the enormous advancements in technology, fraudsters continue to attack the healthcare industry. Numerous recent healthcare security breaches indicate that attackers are focussing on the electronic health data and the drug supply chain. Additional investigation into security problems in the healthcare sector demonstrates that the primary cause of these incidents is the centralisation of data storage. The healthcare sector also lacks immutability, adaptability, security, and privacy in addition to having insufficient documentation. It has been discovered that blockchain technology may offer a complete solution to the main issues the healthcare industry is now facing. Healthcare issues may be resolved with the aid of blockchain's intrinsic qualities, which include immutability, transparency, privacy, security, and documentation. In this work, an interactive blockchain 2.0 medication supply chain tracking system is created, and Hyperledger Calliper is used to measure the system's performance. This system makes sure that everyone involved in the drug supply chain can follow the drug's journey from the producer to the end user. The members' own inventory management is also aided by it. In addition to providing privacy and transparency, this method offers a viable remedy for the issues associated with counterfeit drugs. With one ordered peer and one endorsed peer, the system can process 25,000 transactions per second.

Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia.

Adolescents living with HIV (ALHIV) face unique challenges that result in persistent gaps in achieving and maintaining suppressed viral load. Although effective evidence-based interventions to address treatment gaps in adolescents are readily available, health systems in resource-constrained, high HIV prevalence settings are challenged to implement them to achieve epidemic control. Here, we describe the health system responses to address the treatment gap of unsuppressed ALHIV on antiretroviral therapy in Windhoek, Namibia. We conducted a qualitative descriptive and exploratory study in Windhoek between June and October 2023. Nineteen purposively selected key informants, ranging from pediatric HIV program managers to healthcare providers, were interviewed. In-depth interviews were audio-recorded and transcribed verbatim. The transcripts were uploaded to ATLAS.ti and subjected to thematic analysis. The four main themes elucidated challenges related to adherence and retention as well as health system responses in the form of interventions and support programs. The predominant adherence and retention challenges faced by ALHIV were mental health issues, behavioral and medication-related challenges, and inadequate care and social support. The health system responses to the identified challenges included providing psychosocial support, peer support, optimization of treatment and care, and the utilization of effective service delivery models. Key health system support elements identified included adequately capacitated human resources, efficient medication supply chain systems, creating and maintaining an enabling environment for optimum care, and robust monitoring systems as essential to program success. The health system responses to address the remaining treatment gaps of unsuppressed ALHIV in Windhoek are quite varied and, although evidence-based, appear to be siloed. We recommend harmonized, multifaceted guidance, integrating psychosocial, treatment, care, and peer-led support, and strengthening client-centred differentiated service delivery models for unsuppressed adolescents.

A New Blockchain-Based Medical Model for Smart Hospital Integrity Management of the Drug Supply Chain

Counterfeit medications are currently one of the biggest issues in pharmacology. According to a research from the Health Research Funding organization, between 10–30% of pharmaceuticals in underdeveloped nations are counterfeit. The primary problem is not in counterfeiting per such, but rather in the fact that these pharmaceuticals have distinct adverse consequences on human health when compared to regular drugs. The WHO estimates that over 30% of all medications sold in Latin America, Asia, and Africa are fake. This is the main issue facing the entire world, and things become worse in underdeveloped nations where one in ten medications are either counterfeit or do not adhere to drug standards. It is becoming increasingly challenging to standardize drug safety due to the growth of online pharmacies. It is challenging to identify fakes. The safety of the pharmaceutical supply chain is becoming a serious public health concern, a process that affects all of us. In this work, we present a new approach to medication supply chain management that handles safe drug supply chain data using Hyperledger Fabric, a blockchain-based platform. By implementing drug record transactions on a blockchain, a drug supply chain and smart healthcare ecosystem may be constructed. The suggested method addresses this issue. To allow for time-limited access to patient health information and electronic prescription records, a smart contract has been introduced.

US Generic Antiseizure Medication Supply Chain: Observations from Analysis of US Government Databases

BackgroundGeneric drug manufacturing has shifted away from the U.S. in the last few decades. The medication supply chain, from manufacturers to resellers, has become increasingly globalized and complex. This has led to bottlenecks in their manufacture resulting in medication shortages. Review of this process as it pertains to antiseizure medications (ASM) shows gaps in our comprehension of its complexities. Understanding these processes will be essential for preventing medication shortages. ObjectivesThe aim of this research is to examine the generic ASM supply with an emphasis on production, labeling, and repackaging. MethodsData from the United States Food and Drug Administration (FDA) and the National Library of Medicine (NLM) website DailyMed was used to evaluate supply chain details to gather information on antiseizure medication formulations, manufacturing locations, and labeling. ResultsOut of 3142 ASM-related active National Drug Code (NDC-9) codes, 2663 NDC-9 codes with Abbreviated New Drug Application (ANDA) status were included in the analysis. Most (94.8 %) were enteral, with only 5.2 % being parenteral (intravenous and intramuscular route). We identified the manufacturing country for 82 % of these codes, corresponding to 306 unique ANDA numbers. 119 manufacturing sites in 12 countries produce generic ASM Finished Dosage Forms (FDF): 103 for enteral and 21 for parenteral. India is the main producer of enteral ASM FDFs with 49 sites, followed by the US with 36. Regarding parenteral formulation, five countries had 21 unique manufacturing locations. 42 % of the 103 enteral ASM FDFs manufacturing sites produced multiple ASM FDFs, with one facility making eight distinct ASMs. 34.4 % of facilities were associated with over 3 ANDAs, and 15.1 % with more than 5. 22.7 % of ANDAs lacked a manufacturing facility identifier. Repackaged ASM FDFs constituted 48 % of NDC-9 s. Gabapentin and pregabalin were the most common oral ASMs. ConclusionsIndia is the major source for generic ASM FDFs manufacturing, leading to concerns about overall supply dependency on that country. There is a paucity of facilities for the global supply of parenteral ASM FDFs. There is missing data for many NDC-9 codes emphasizing urgency for transparency in the supply chain.

Providing continuity of care for people living with noncommunicable diseases in humanitarian settings: A qualitative study of health actors' experiences in Lebanon

ObjectiveThe burden of non-communicable diseases (NCDs) is increasing among populations living in humanitarian settings. Continuity of care (CoC) involves following an individual over time and across different levels of healthcare (management, longitudinal, informational and interpersonal continuity); it is an essential component of good quality, person-centred NCD care. Providing CoC is particularly challenging in humanitarian crises where health care access may be interrupted or restricted. This paper aimed to explore health actors’ experiences of continuity of hypertension and diabetes care for Syrian refugees and vulnerable Lebanese in Lebanon. MethodsWe conducted 20 in-depth qualitative interviews with health actors, including eleven with health care providers at four urban-based health facilities supported by international humanitarian agencies that provide NCD care to Syrian refugees and vulnerable Lebanese, one representative of a governmental institution, one international delegate and seven humanitarian actors. Thematic analysis, combining inductive and deductive approaches, was guided by a conceptual framework for NCD models of care in humanitarian settings. We reported our findings against the conceptual framework's domains relating to health system inputs and intermediate goals, reflecting on their impact on the domains of CoC. FindingsExisting health system weaknesses and novel challenges (the economic crisis, COVID-19 pandemic and Beirut blast) to continuity of NCD care were identified. Health system input challenges: governance and financing (weakened governance, limited central financing, historical dependence on local NGOs for primary healthcare, a dominant private sector), health workforce (exodus of health care providers from the public system), inconsistent medicines and equipment supplies, and limited health information systems (no unified system across institutions or levels of care, lack of formal referral systems, and inconsistent facility-level data collection) contributed to limited public primary care, poorly integrated within a fragile, pluralistic health system. These factors negatively impacted the intermediate health system goals of access, standardisation and quality of NCD care for Syrian refugee and Lebanese patients, and collectively hampered the management, longitudinal, informational and interpersonal continuity of NCD care in Lebanon. ConclusionWe recommend that humanitarian actors continue the work underway with the Lebanese Ministry of Public Health to align with and strengthen health system inputs, including supporting health governance through the accreditation process, exploring new funding mechanisms, strengthening the workforce via task sharing and training, supporting the medication supply chain, improving access to facilities and service quality, and supporting the development, standardisation and interoperability of referral and information systems. In combination, these elements will support better CoC for people living with hypertension and diabetes in Lebanon.

Research on Complex Optimization Models and Efficient Algorithms for Medications Supply Chain during Major Epidemic

The outbreak of the epidemic has had a huge impact on people's lives and economies. Research on the medications supply chain during major epidemic events is a major focus of people's attention and an important part of emergency management work, which is related to the vital interests of people and production enterprises. The supply of medications is an important foundation for the smooth implementation of emergency management work. Based on this, this article conducts empirical research on the multi-product two-level medication supply chain of a pharmaceutical company in Shanghai through optimization models. The medication supply chain consists of three warehouses, each equipped with two types of medications, A and B, which need to be transported to seven disaster-stricken medication demand points. Establish a relevant linear programming model to minimize transportation costs, and then use Lingo software to solve the model. The obtained data results are analyzed, the optimal solution is given, and the model is verified to be the optimal result. Meanwhile, a comparative analysis was conducted on the costs of the supply chain optimization strategy and non-optimization strategy. The research results indicate that the optimal solution not only minimizes transportation costs but also has the shortest transportation path, which can transport medications to various affected areas at the fastest speed, avoiding secondary damage caused by medications shortages in affected areas and ensuring smooth emergency management work.

Medication supply chain resilience during disasters: exploration of causes, strategies, and consequences applying Strauss and Corbin's approach to the grounded theory

BackgroundDue to the importance of procurement of medicines and medical supplies during disasters and the significance of an existing resilient supply chain, the present study aimed to explore the causes, strategies, and consequences of the medication supply chain resilience during the Kermanshah, Iran, earthquake experience in 2018.MethodsThis was a qualitative study based on the grounded theory method. The suggested approach by Strauss and Corbin was used. Thirty-two in-depth and semi-structured interviews were conducted via theoretical sampling, and data were saturated. Open-ended and probing questions were used, and all the interviews were recorded with the prior permission of the participants. Field notes and memoing were also used along with the interviews. Transcribed data were analyzed in three levels of open coding, selective, and axial coding by two researchers with sufficient reflexivity without any conflict of interest.ResultsThe results led to the identification of eight main categories, including "Disaster Management Structure", "Information Management", "Supply Chain Monitoring", "Socio-Cultural Factors", "Planning", "Resource Management", "Medical Service Coverage", and "Waste of time and resources". According to Strauss and Corbin's model, socio-cultural factors and inappropriate structures and planning related to the health system during disasters may waste time and resources.Conclusions"Waste of time and resources” during disasters can be considered the main determinant that can damage the resilience of the medication supply chain. Policymakers need to seek applied strategies for decreasing waste. Socio-cultural interventions, preparedness of information infrastructures and coordination among the stewards and the community during disasters can help the supply chain preserve its resilience and act more effectively.

458 Medicines management of long-term conditions during the COVID19 pandemic: a narrative systematic review

Abstract Introduction Due to lockdown measures associated with the COVID 19 pandemic (1), there were substantial changes to healthcare delivery, including the suspension of face-to-face medical appointments, expansion of telehealth and changes to medication protocols.(2) It is important to learn from the successes and challenges of this period to ensure we adapt and improve how we support people to take medicines in the future. Aim We sought to conduct a systematic review to explore the different approaches used to deliver medicines management services for people living with long term conditions (LTCs) during the pandemic and identify strategies that could be integrated into standard care. Methods We conducted a systematic review across 3 large databases: MEDLINE (OVID), EMBASE (OVID) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Our research question and search strategy was developed using the PICO framework (Population: adults with LTCs, Intervention: medicines management during the COVID 19 pandemic; no comparison group. Outcome: any aspect relating to medicines management. Search terms relating to ‘long term conditions’, ‘medication management’ and ‘COVID-19’ were used. One reviewer (LM) screened all titles, abstracts, and full texts. We included studies discussing medication management of LTCs, in patients of all ages and healthcare settings, throughout the pandemic. Primary literature sources, feasibility studies and case studies, were included. We excluded studies solely focusing on disease monitoring, or the treatment of COVID/ ‘long Covid’. One reviewer performed a thematic analysis, synthesising the findings into themes and sub-themes, which were discussed with a further reviewer (CT). A critical appraisal was performed using the Critical Appraisal Skills Programme checklists. Results The search returned 2365 results. After deduplication, articles were removed at the title (n=1070) abstract (n=813) and full text (n=232) stages. 31 studies were included. Studies were conducted in India (n=6), US (n=5), international (n=4), France (n=2), Italy (n=2), and one each from China, Japan, Jordan, Mexico, Morocco, Nigeria, Romania, Saudi Arabia, Spain, UK, UK and US, and location not specified. Most studies (n=17) employed subjective methods of data collection (surveys/ questionnaires). We identified 6 themes. These were: changes in consultation type, for instance using teleconsultations and smartphone apps to monitor glucose control and diabetic management. Studies described temporary changes to treatment protocols e.g., using oral chemotherapy to reduce the need for in-person appointments and reduce the infection risk associated with intravenous administration. Control of certain conditions for example epilepsy was reduced in some studies. Patients missed doses due to drug shortages associated with disruptions in the medication supply chain, particularly in low-income countries. Finally, we identified prescribing trend changes in certain classes of medicines (e.g. reduced biologic usage due to immunosuppression risk) and an increase in patients self-medicating conditions including anxiety and depression, with associated safety risks. Conclusion This review suggested that certain medical conditions such as diabetes and hypertension were more suited to remote monitoring with technological interventions such as smartphone apps. While other conditions e.g., cancer and epilepsy, demonstrated a greater need for in-person care. Countries of lower socioeconomic status were disproportionately affected by the pandemic.

Industry 4.0 for Pharmaceutical Manufacturing; Smart Factories for Future

The use of cutting-edge technology like artificial intelligence, machine learning, the Internet of Things (IoT), and big data analytics in manufacturing processes is referred to as industry 4.0, also referred to as the fourth industrial revolution. Industry 4.0 has the potential to completely transform medication research, production, and supply chain activities in the pharmaceutical sector, resulting in more productivity, reduced prices, and better quality. Real-time monitoring of manufacturing processes and supply chain operations is made possible by the implementation of Industry 4.0 technologies in the pharmaceutical manufacturing industry. This can help identify potential problems and enhance decision-making. IoT devices can be used to monitor and improve equipment performance and anticipate maintenance requirements, resulting in less downtime and more productivity. Large data sets can be examined by advanced analytics and machine learning algorithms to spot patterns and abnormalities. Advanced analytics and machine learning algorithms can also scan huge data sets to find trends and abnormalities, making it possible to discover quality problems more quickly and to comply with regulations. Faster medication development, more effective manufacturing techniques, and ultimately improved patient outcomes can result from this.

The Blockchain Technologies in Healthcare: Prospects, Obstacles, and Future Recommendations; Lessons Learned from Digitalization

For today's healthcare data management systems, fundamental problems are data transparency, traceability, immutability, audit, data provenance, flexible access, trust, privacy, and security. Blockchain is a promising technology that can help to optimise healthcare data management operations by increasing data efficiency and ensuring trust. The current study examined the usefulness of blockchain technology in healthcare and the barriers to adoption. Finally, we looked at the future of blockchain technology in healthcare. The current study reviewed 53 papers and utilised the PRISMA framework 2020 to include and exclude records from the Scopus database. The VOS Viewer software is used to categorize the published literature, and the prevalence of essential terms is often used to authenticate the main themes in classifications. The current study findings indicate that Blockchain offers a wide range of applications and functions in healthcare. By allowing the transfer of patient medical information, controlling the medication supply chain, and facilitating the safe transfer of patient medical records, blockchain technology assists healthcare researchers in discovering genetic codes. Because blockchain can support novel analytics, healthcare firms may notice changes in their data in real-time, allowing them to make swift choices without human involvement

Price and Quality in the Generic Pharmaceutical Market.

Price and Quality in the Generic Pharmaceutical Market.

Securing Drug Distribution Systems from Tampering Using Blockchain

The purpose of this study is to overcome coordination flaws and enhance end-to-end security in the drug distribution market (DDM). One of the major issues in drug market coordination management is the absence of a centralized monitoring system to provide adequate market control and offer real-time prices, availability, and authentication data. Further, tampering is another serious issue affecting the DDM, and as a consequence, there is a significant global market for counterfeit drugs. This vast counterfeit drug business presents a security risk to the distribution system. This study presents a blockchain-based solution to challenges such as coordination failure, secure drug delivery, and pharmaceutical authenticity. To optimize the drug distribution process (DDP), a framework for drug distribution is presented. The proposed framework is evaluated using mathematical modeling and a real-life case study. According to our results, the proposed technique helps to maintain market equilibrium by guaranteeing that there is adequate demand while maintaining supply. Using the suggested framework, massive data created by the medication supply chain would be appropriately handled, allowing market forces to be better regulated and no manufactured shortages to inflate medicine prices. The proposed framework calls for the Drug Regulatory Authority (DRA) to authenticate users on blockchain and to monitor end-to-end DDP. Using the proposed framework, big data generated through drug supply chain will be properly managed; thus, market forces will be better controlled, and no artificial shortages will be generated to raise drug costs.

The Utility of Planned Deprescribing in Pandemics and Other Disasters: A Systematic Review

How can psychiatrists best provide care in complex, sometimes overwhelming disasters? COVID-19 strained every aspect of health care to the breaking point, from finances to pharmaceutical supply lines. We can expect more challenges to prescribing in the future, as shown by recent hurricanes in Puerto Rico, fires in California, and ice storms in Texas. When medications become scarce or inaccessible, then clinicians need to make difficult prescribing decisions. We suggest that a culture of deprescribing, a systematic approach to reducing or simplifying medications, could be applied to a wide variety of crises. Deprescribing is defined as the planned reduction of medications to improve patient health or to reduce side effects (see deprescribing.org). It has been used to reduce polypharmacy in geriatric and other complex populations. It provides evidence-based guidance for phasing out many classes of medications. It is part of the larger program to reduce waste in health care and to make pharmacy more rational. Disasters and resource scarcity, however, require a different approach. In contrast to routine care focused on individual patients, crisis standards of care (CSC) shift the clinical focus to the community. Instead of deprescribing guidelines for individual clinicians, CSC deprescribing would be national policies addressing shortages of important medications. We did a scoping review looking for studies of deprescribing in a crisis. We extracted 1340 references in Google Scholar 2016 to 2021 using (deprescribing) AND (disaster OR crisis OR climate OR pandemic OR supply lines). A scan of texts found 160 references matching our criteria, and only 19 of them addressed deprescribing as a strategy to strengthen health systems or providers in an emergency. Most of those were related to scarce supplies during COVID, and a few addressed the carbon impact of medications. We also reviewed related literatures on medication supply chain vulnerabilities, WHO Essential Medicines, and healthcare rationing. Deprescribing gained attention during the COVID pandemic, responding to both disrupted supply lines and improving patient safety. Writers concerned with climate change support deprescribing to reduce the carbon impact of medications. Deprescribing as crisis policy could help streamline national stockpiles, supply chains, and manufacturing. Education could make deprescribing second nature for clinicians, potentially decreasing stress and increasing flexibility in future emergencies. Barriers to deprescribing generally include cultural inertia, industry lobbyists, education, and malpractice fears. In a crisis, deprescribing guidelines could provide clinicians with confidence and flexibility while conserving scarce resources. Research is needed to evaluate deprescribing guidelines for crises, especially ensuring equity in how they reduce polypharmacy and save money. No funding.

Medication supply chain risk management for a brazilian home care provider: a business sustainability study

Health services are rapidly growing around the world and the supply chain risk management (SCRM) is imperative to achieve business sustainability in the long-term perspective. The present research aims to identify the risks in a home care health service provider, evaluating the potential failures causes and establishing actions to reduce the likelihood of patients’ harm associated with medication process flaws. We conducted a single case study, evaluating and identifying possible risks in a health services company located in Brazil. Although the results of the present research have no statistical basis to support quantitative inferences, an approach based on qualitative criteria can be replicated. We followed a logical sequence of steps to manage the medicines and hospital products’ supply risks, using standards and risk management (RM) tools widely applied by the professional and academic community. As main results, it was observed that “wrong material kit supply” as the most relevant issue for SCRM. As practical implications, this research has the potential to prevent people who depend on home care services, from receiving incorrect medicines (or failing to receive them). In extreme cases, such as the administration of medications that were incorrectly sent to patients, deaths can be avoided, since those involved in the outbound logistic processes will have the ability to work proactively in mitigating actions that avoid this type of risk.

Eliminating malaria in conflict zones: public health strategies developed in the Sri Lanka Civil War

Despite the 26-year long civil war, Sri Lanka was declared malaria-free by WHO in 2016. This achievement was the result of nearly 30 years of elimination efforts following the last...

Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study

BackgroundImplementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program.MethodsPurposive sampling in 8 PHCs identified patients (n = 8), non-physician health workers (n = 12), administrators (n = 3), and primary care physicians (n = 6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation.ResultsParticipants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment, (2) enable and empower community healthcare workers to participate in team-based care through training and education, (3) information systems to track patients and medication supply chain, and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: accessible and person-centered care, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could be addressed with better communication, home visits, and drug financing. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to improve knowledge and demand for the HTN Program.ConclusionsThese results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria, with the ultimate aim of scaling it to other parts of the country.

ASHP Foundation's forecast report feels more relevant than ever this year

ASHP Foundation's forecast report feels more relevant than ever this year

Solving the problem of access to cardiovascular medicines: revolving fund pharmacy models in rural western Kenya

Availability of medicines for treatment of cardiovascular disease (CVD) is low in low-income and middle-income countries (LMIC). Supply chain models to improve the availability of quality CVD medicines in LMIC...

Leveraging Existing Strategies of Medication Stewardship to Preserve and Appropriately Use Critical Supplies

The coronavirus disease 2019 (COVID-19) pandemic has placed substantial stress on the health care delivery system and exposed strengths and weaknesses that may have been previously underappreciated. A serious issue that emerged was the vulnerability of our medication supply chain, and potential ways to boost or preserve the supply of important medications have been reported.1 The existing health system infrastructure is critical to these efforts and can be used to help steward these vital resources and manage increasing demands.

COVID-19 and Drug Shortages: A Call to Action.

The ever-vulnerable medication supply chain is being further strained by the COVID-19 pandemic. Pharmacists in all settings, including managed care, will need to prepare for a potential exacerbation of existing and new drug shortages in the midst of unprecedented crisis. We summarize the major issues, discuss potential mitigation strategies, and call on our colleagues to respond with the resilience necessary to protect our patients. DISCLOSURES: The authors declare no funding sources nor conflicts of interest.