Pharmacy Supply Research Articles

Predicting pharmaceutical supply chain disruptions before and during the COVID-19 pandemic.

Disruptions to the pharmaceutical supply chain (PSC) have negative implications for patients, motivating their prediction to improve risk mitigation. Although data analytics and machine learning methods have been proposed to support the characterization of probabilities to inform decisions and risk mitigation strategies, their application in the PSC has not been previously described. Further, it is unclear how well these models perform in the presence of emergent events representing deep uncertainty such as the COVID-19 pandemic. This article examines the use of data-driven models to predict PSC disruptions before and during the COVID-19 pandemic. Using data on generic drugs from the pharmacy supply chain division of a Fortune 500 pharmacy benefit management firm, we have developed predictive models based on the naïve Bayes algorithm, where the models predict whether a specific supplier or whether a specific product will experience a supply disruption in the next time period. We find statistically significant changes in the relationships of nearly all variables associated with product supply disruptions during the pandemic, despite pre-pandemic stability. We present results showing how the sensitivity, specificity, and false positive rate of predictive models changed with the onset of the COVID-19 pandemic and show the beneficial effects of regular model updating. The results show that maintaining model sensitivity is more challenging than maintaining specificity and false positive rates. The results provide unique insight into the pandemic's effect on risk prediction within the PSC and provide insight for risk analysts to better understand how surprise events and deep uncertainty affect predictive models.

Effect of nirsevimab on hospitalisations for respiratory syncytial virus bronchiolitis in France, 2023–24: a modelling study

Respiratory syncytial virus (RSV) is a major cause of hospitalisations and deaths among infants worldwide. France was one of the first countries to implement a national programme (beginning on Sept 15, 2023) for administration of nirsevimab, a single-dose long-acting monoclonal antibody treatment, to infants born on or after Feb 6, 2023, to prevent lower respiratory tract infection caused by RSV. We aimed to estimate the effectiveness of nirsevimab and the number of hospitalisations averted in children younger than 24 months in real-world settings. In this modelling study, we developed an age-structured deterministic model characterising RSV transmission as well as plausible scenarios for the administration of nirsevimab doses based on maternity ward and community pharmacy supply data. We retrospectively estimated nirsevimab effectiveness in infants younger than 24 months during the 2023-24 RSV season in France (excluding overseas territories) and the number of averted hospitalisations for RSV bronchiolitis occurring after emergency department visits, by calibrating the model to hospital and virological surveillance data from Aug 21, 2017, to Feb 4, 2024, alongside serological data from a previous cross-sectional study. To assess the robustness of our estimates, we conducted sensitivity analyses in which we modified our assumptions about the number of doses administered, the reconstruction of the number of RSV-associated hospitalisations for bronchiolitis, the duration of maternal and post-infection immunity to RSV, and the number of contacts in children aged 0-2 months. We estimated that nirsevimab administration prevented 5800 (95% credible interval 3700-7800) RSV-associated hospitalisations for bronchiolitis after emergency department visits among children younger than 24 months, including 4200 (2900-5600) hospitalisations among those aged 0-2 months, between Sept 15, 2023 (the date nirsevimab was introduced), and Feb 4, 2024-a 23% (16-30) reduction in the total number of hospitalisations and a 35% (25-44) reduction in the 0-2 months age group, compared with the scenario without administration. In our baseline scenario, in which we estimated that 215 000 doses of nirsevimab were administered by Jan 31, 2024, the estimated effectiveness against RSV-associated hospitalisations for bronchiolitis was 73% (61-84), corresponding to one hospitalisation averted for every 39 (26-54) doses administered. In sensitivity analyses, nirsevimab remained effective against RSV-associated hospitalisations for bronchiolitis after emergency department attendance. Our findings show that nirsevimab administration campaigns could effectively reduce the RSV-related hospital burden of bronchiolitis in children younger than 24 months. European Commission, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases programme, and INCEPTION project.

Exploring the Proof of Work Based Block Chain Algorithm for Pharmaceutical Industry Supply Chain Innovation

Block chain technology offers numerous promising opportunities for improving supply chain management. This article provides a brief outline of how Block chain technology is being utilized in the supply chain industry. The article is proposed to explain how the Block chain might help suppliers, manufacturers, regulators, quality assurance labs, and logistics operators by cooperating on a shared ledger, as well as to establish provenance for speciality products at the package level and to reduce income leakage to pharmaceuticals. A Block chain-based pharmacy supply chain management track and trace system could tackle this growing illegal economy by tracking medicine through suppliers, manufacturers, wholesale distributors, pharmacies, hospitals, regulators, and logistics. In this paper it is proposed to display proof of work (PoW) based Block chain algorithm to stop counterfeit medications entering a pharmaceutical supply chain and to enhance transparency, traceability, and security highlighting the merit of PoW algorithm.

New Zealand community pharmacists’ perspectives on supplying smoked tobacco as an endgame initiative: a qualitative analysis

IntroductionTobacco endgame strategies often include measures to reduce tobacco availability by decreasing retailer numbers. Recently, some US pharmacies have delisted tobacco, though overall retailer numbers have not reduced markedly. Paradoxically,...

Medication supply at hospital discharge via community pharmacy: a quality improvement study.

Patient delays at the point of their discharge account for more than half a million additional bed days every year in Scotland, United Kingdom. Bottlenecks in discharge medication dispensing contribute to such delays. To test whether the discharge process could be made more time-efficient by utilising community pharmacy supply of medicines on the day of discharge, rather than hospital pharmacy supply. Glasgow Royal Infirmary, Scotland. Local community pharmacy staff received training and communication about each patient discharge. Pharmacies could access an immediate discharge letter (IDL) on a shared electronic record. The existing pandemic law allowed medication dispensing from this IDL, without a prescription. The programme was implemented from June to November 2020, across three Plan-Do-Study-Act (PDSA) cycles. Comparisons were made between the new community pharmacy model and standard hospital model. Across three PDSA cycles, in total 335 patients had community pharmacy supply compared to 376 patients eligible for hospital pharmacy supply. The median time taken from creation of the IDL to final completion was significantly lower in the new community pharmacy model compared to the hospital pharmacy model; 154min (interquartile range (IQR) 82-272min) vs 296min (IQR 197-1281min) p value < 0.000 CONCLUSION: A community pharmacy supply model compared to a standard hospital pharmacy model resulted in a median time saving of 142min per patient. Such a time saving has the potential to deliver a transformational change in patient flow and free up hospital pharmacy staff to deliver other clinical interventions.

Opioid use disorder treatment and the role of New Jersey Medicaid policy changes: perspectives of office-based buprenorphine providers

ABSTRACT Background: In the US, seventy percent of drug-related deaths are attributed to opioids. In response to the ongoing opioid crisis, New Jersey’s (NJ) Medicaid program implemented the MATrx model to increase treatment access for Medicaid participants with opioid use disorder (OUD). The model’s goals include increasing the number of office-based treatment providers, enhancing Medicaid reimbursement for certain treatment services, and elimination of prior authorizations for OUD medications. Objectives: To explore office-based addiction treatment providers’ experiences delivering care in the context of statewide policy changes and their perspectives on treatment access changes and remaining barriers. Methods: This qualitative study used purposive sampling to recruit office-based New Jersey medications for opioid use disorder (MOUD) providers . Twenty-two providers (11 females, 11 males) discussed treatment experiences since the policy changes in 2019, including evaluations of the current state of OUD care in New Jersey and perceived outcomes of the MATrx model policy changes. Results: Providers reported the MOUD climate in NJ improved as Medicaid implemented policies intended to reduce barriers to care and increase treatment access. Elimination of prior authorizations was noted as important, as it reduced provider burden and allowed greater focus on care delivery. However, barriers remained, including stigma, pharmacy supply issues, and difficulty obtaining injectable or non-generic medication formulations. Conclusion: NJ policies may have improved access to care for Medicaid beneficiaries by reducing barriers to care and supporting providers in prescribing MOUD. Yet, stigma and lack of psychosocial supports still need to be addressed to further improve access and care quality.

How COVID-19 affected pharmacy supply of antibiotics for uncomplicated urinary tract infections

In February 2021, we reported on an evaluation of our community pharmacy patient group direction (PGD) service for the management of suspected urinary tract infections (UTI) in females​[1]​. That report looked at 271 supplies of nitrofurantoin recorded by the PharmOutcomes platform during July 2019. All 271 women were recorded as receiving a ‘Treat antibiotics responsibly, guidance, […]

Safety Stock, Warehouse Capacity, and Return of Goods in Inventory Model Development

With the increasing level of competition between companies, companies are required to be able to manage their inventory system optimally. In the pharmacy supply system, it is important to consider the uncertainty factor because the demand for medicines depends on the uncertain nature of the disease, besides that there is an expiration factor that must be considered because medicines must have an expiration date. To solve the problem of expiration, the supplier usually provides a return policy in accordance with the specified conditions. In addition, pharmacies also have limitations on warehouse capacity that must be considered. To solve the problem of limited warehouse capacity in this study, an approach to the requirements of the Karush Kuhn-Tucker method was used. From the developed model, two ordering times are obtained, namely and which will be compared to get the optimal ordering time. From the analysis of the model, it is found that the more characteristic considerations in an inventory system, the greater the total inventory cost.

Pharmacy Champion Award.

New Hampshire House of Representatives member Gary Merchant, MBA, RPh, and the Colorado Pharmacists Society are the 2022 recipients of the ASHP Board of Directors Pharmacy Champion Award. The award recognizes leadership in advocacy and public policy that helps to improve patient care, drug safety, and medication-use outcomes and advances the vital roles pharmacists play as patient care providers. Merchant is a subject-matter expert on the 340B Drug Pricing Program and the orphan drug exclusion, the pharmacy supply chain, and hospital pharmacy management. He is an avid champion for advancing pharmacists’ scope of practice, expanding reimbursement for services provided by a pharmacist, and fostering medication safety and positive health outcomes. He played a major role in facilitating legislation that recognizes pharmacists as healthcare providers under Medicaid and expands pharmacists’ authority to prescribe medications for tobacco cessation. Merchant also championed legislation creating a new license category for advanced pharmacy technicians authorizing them to perform most technical dispensing functions without the review or approval of a licensed pharmacist.

Cost Analysis of Individual Outpatient and Emergency Pharmacy Services in the Kingdom of Saudi Arabia

PTB Reports,2022,8,1,12-18.DOI:10.5530/PTB.2022.8.2Published:April 2022Type:Research ArticleAuthors:Mona Yaser Alsheikh, Raghad Abdulaziz Alasmari, Asma Saqer Alamri, Bandar Awwadh Alosaimi, and Yousef Ahmed Alomi Author(s) affiliations:Mona Yaser Alsheikh,* PharmD, MSc,PhD, FHEA Department of Clinical Pharmacy, College of Pharmacy, Taif University, KSA. Raghad Abdulaziz Alasmari, Pharm D College of Pharmacy, Taif University, KSA. Asma Saqer Alamri, Pharm D College of Pharmacy, Taif University, KSA. Bandar Awwadh Alosaimi, Pharm D College of Pharmacy, Taif University, KSA. Yousef Ahmed Alomi, BSc. Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE Critical care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor, and Data Analyst, Riyadh, KSA. Abstract:Objectives: In this study, we aimed to explore the cost of Individual outpatient and emergency pharmacy services in the Kingdom of Saudi Arabia. Methods: This is a descriptive analysis crosssectional and questionnaire-based study. We used an electronic survey questionnaire with a judgment sampling system to obtain responses. The structured questionnaire consisted of two parts written in English and Arabic. The first part collected the demographic information of the responders based on multiple-choice questions. The second part contained questions for measuring the personal cost, including the salary cost of a head of ambulatory care or outpatient pharmacist, a clinical pharmacist working at ambulatory care, pharmacist and pharmacy technician, and secretary and porter per hour. The cost was calculated for the preparation time of each medication. The total costs of the place’s overhead cost and cost of equipment used for the outpatient and emergency pharmacy services. Furthermore, the purchased materials and supplies and the non-salary cost were calculated. All costs were used in the US dollar currency. The data were collected through the Survey Monkey system and analyzed using Microsoft Excel version 2020. Results: The total of judgment responders was six directors of pharmacy. Five were responsible for outpatient pharmacy services, and one was responsible for emergency pharmacy. The majority of the outpatient and emergency pharmacy directors had work experience as pharmacy administrators for more than four years. The total cost of outpatient pharmacy services was 1581.95 USD, whereas the cost of emergency pharmacy services was 729.86 USD. The majority of the cost came from personnel cost from the outpatient pharmacy (1288.15 USD, 81.43%) followed by emergency pharmacy (465.28 USD, 63.75%) and material and supply cost (205 USD, 13.01%) at the outpatient pharmacy and emergency pharmacy services (228.89 USD, 31.36%). Conclusion: This study conducted the cost analysis of separate outpatient and emergency pharmacy services. Standardized pharmacy administrative and clinical activities are required, and we recommend more additional studies with a large sample size in the Kingdom of Saudi Arabia. Keywords:Cost, Emergency, Kingdom of Saudi Arabia, Outpatient, Pharmacy, SeparateView:PDF (165.7 KB) PDF PDF Images Cost Analysis of Individual Outpatient and Emergency Pharmacy Services in the Kingdom of Saudi Arabia

Homeward.

Homeward.

Fundamental issues and pandemic pushes pharmacists past their limits

Fundamental issues and pandemic pushes pharmacists past their limits

Lessons from pandemic bolster response to weather emergency.

Ochsner Health’s experience with remote work during the COVID-19 pandemic helped the health system weather Hurricane Ida, which made landfall Sunday, August 29, 2021, approximately 100 miles from New Orleans in Port Fourchon, LA. Deborah Simonson, system vice president of pharmacy services for the health system, and Ryan Pepper, assistant vice president for the pharmacy supply chain, remained onsite at Ochsner Medical Center in New Orleans throughout the storm. But other system pharmacy leaders who normally ride out weather emergencies were positioned far from Ida’s path to provide continuous remote support. “Before COVID-19, we had a lot more people come onsite,” Simonson said. “With Hurricane Ida, we had to follow COVID-19 safety protocols, so we could not have our entire Team A on site. We really depended on support that we’d moved outside the impact zone.” She said the leadership team functioned as a command center to handle urgent requests from hospitals for supplies, staffing, and other assistance. Despite some storm-related communication issues, the overall process worked well, and Simonson said she wants to refine this model and use it during future emergencies.

Establishment of disaster medical assistance team standards and evaluation of the teams’ disaster preparedness: An experience from Taiwan

Taiwan set up disaster medical assistance teams (DMATs) after the Chi-Chi earthquake, but these teams lack unified standards. This study was divided into two phases. Phase I was a Delphi study conducted in 2019 with 26 experts who were invited to establish Taiwan's DMAT standards by modifying the World Health Organization Emergency Medical Team (WHO EMT) type I fixed standards. Phase II was a cross-sectional study conducted in 2020. A questionnaire was used to evaluate the disaster preparedness of DMATs by standards set in phase I. In phase I, Taiwan's DMAT standards were established after three rounds of Delphi consensus, with a response rate of 88.5%. The major departures from the WHO EMT standards were the exclusion of obstetric care, mental health, rehabilitation, and laboratory and blood transfusion standards and the addition of an ultrasound standard. During phase II, a total of 32 teams were invited, and the response rate was 96.9%. The overall standard achievement rate was 56.9%, and the three lowest achievement rates corresponded to sanitation (22.6%), medical malpractice insurance (25.8%), and pharmacy and drug supply (25.8%). The national DMATs, official DMATs, DMATs funded by government, and DMATs with ≥10 years of experience had significantly higher achievement rates for partial or overall standards. Using localized standards to evaluate the disaster preparedness of each team, DMATs were found to have many shortcomings mainly due to the lack of unified government announcement standards, legal protection, and adequate financial support.

ASHP national survey of pharmacy practice in hospital settings: Impact of COVID-19 pandemic on pharmacy operations-2020.

Results of the 2020 ASHP national survey of pharmacy practice in hospital settings pertaining to pharmacy operational changes implemented in response to the coronavirus disease 2019 (COVID-19) pandemic are presented. Pharmacy directors at 1,437 general and children's medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. The response rate was 18.7%. Seventy-three percent of hospitals implemented changes to hospital units, including 46% that increased intensive care unit bed capacity; 94% made changes to pharmacy supply chain acquisition, changes to products, and/or increased inventory. Staffing changes were implemented by 69% of hospitals, with the most common being staffing reductions (55%) and salary reductions (16%). Medication-use changes were implemented by 86% of hospitals, with treatment guidelines for COVID-19 treatment (79%) and opening compassionate use or investigational drug studies (55%) being the most common. Changes in sterile compounding processes were implemented by 84% of hospitals. Personal protective equipment (PPE) shortages led to 71% of hospitals modifying PPE use standards in sterile compounding. Eighty-seven percent of hospitals changed operational activities, such as changing medication return practices (56%), medication reconciliation processes (46%), intravenous medication recycling (38%), and discharge counseling (37%). Hospitals experienced shortages of many medications, including albuterol inhalers (60%), sedatives and anesthetic agents (58%), neuromuscular blockers (43%), corticosteroids (34%), cardiovascular agents (24%), investigational agents (24%), and dialysis solutions (6%). The pharmacy profession responded to myriad threats to operations and patient care during the COVID-19 pandemic in 2020.

The Impact of Medication Cost on Dialysis Patients.

Americans spend more money on prescription drugs than any other nation in the world. In 2018, spending on medicines, including over-the-counter drugs, in the United States was $1229 per person. This cost really sets us apart from most other countries (1). In Europe, the second-largest pharmaceutical market after the United States, governments negotiate with the drug companies directly, limiting what their health systems pay. The US free market economy, however, does not allow for direct negotiation with drug companies. Instead, the compensation of numerous stakeholders (from insurance companies to pharmacy benefit managers) is negotiated throughout the pharmacy supply chain, adding considerably to the final cost of medications (2). The result of these drug cost disparities is that people in the United States are far more likely to do without medications due to cost concerns. One in five US adults (11% of all patients) said they failed to complete a prescribed course of medicine because of cost. People with CKD and ESKD are even more profoundly affected by medication costs. Among patients enrolled on Medicare, per person per year out-of-pocket costs for Medicare Part D covered drugs in 2018 were $440 for all patients with ESKD, $381 for those on hemodialysis, and $569 for those on peritoneal dialysis (3). Between 2009 and 2018, total Medicare Part D spending, in inflation-adjusted dollars, rose by approximately 80% in those with ESKD (from US$1.9 billion to US$3.4 billion) and by approximately 50% in those without ESKD (from US$44.0 billion to US$67.3 billion). This increase is due to both the increased numbers of patients with CKD and ESKD, and to higher …

The challenges of drug shortages in the Canadian hospital pharmacy supply chain — a systematic literature review

The aim of this paper is to highlight current knowledge gaps that exist with regard to the factors which affect the supply chain, and the inventory management strategies that are utilized by hospital pharmacies in Canada which could lead to drug shortages. This research implements an optimal SLR (systematic literature review) method on drug shortages based on CHPSC (Canadian hospital pharmacy supply chain) literature and databases. This makes it possible to perform a wide review of Canadian hospital pharmacies and understand how continued disruption occurred in this process and caused drug shortages. The result of this research is contained in a systematic search methodology which consists of four main tasks, namely: a) building an optimal review process, b) defining search procedures, c) validating the search procedures, and d) conducting literature search. Furthermore, the researchers conducted a SLR which unveiled issues and factors such as raw materials availability and increases in demand which cause drug shortages. In conclusion, the proposed systematic methodology seeks to highlight possible solutions to the supply chain management issues which could cause drug shortages in Canada. Various solutions are proposed and explored, with the relevant information being obtained from studies conducted on how to mitigate the impact on supply chain management.

Operationalizing Pandemic Vaccinations at a Regional Supermarket Chain Pharmacy

Community pharmacies were underutilized as vaccination locations during the 2009 H1N1 pandemic. Since that time, community pharmacies are a common location for seasonal influenza vaccinations with approximately one-third of adults now getting vaccinated at a pharmacy. Leveraging community pharmacies to vaccinate during a pandemic such as pandemic influenza or the current coronavirus disease (COVID-19) pandemic will result in a more timely and comprehensive public health response. The purpose of this article is to summarize the results of a strategic planning meeting held in 2017 that focused on operationalizing pandemic influenza vaccinations at a regional supermarket chain pharmacy. Participating in the planning session from the supermarket chain were organizational experts in pharmacy clinical programs, managed care, operations leadership, supply chain, information technology, loss prevention, marketing, and compliance. Additionally, experts from the county and state departments of health and university faculty collaborated in the planning session. Topics addressed included (1) establishing a memorandum of understanding with the state, (2) developing an internal emergency response plan, (3) scaling the pandemic response, (4) considerations for pharmacy locations, (5) staffing for pandemic response, (6) pandemic vaccine-specific training, (7) pharmacy workflow, (8) billing considerations, (9) documentation, (10) supplies and equipment, (11) vaccine supply chain, (12) communications, and (13) security and crowd control. Information from this planning session may be valuable to community pharmacies across the nation that seek to participate in COVID-19 pandemic vaccinations.

Mobile Pharmacies Throughout History.

Background:Mobile pharmacies are special organizational units or infrastructures that serve to supply medicines to remote communities or are stationed on ships or as such exist during war conflicts on the battlefields to provide first aid to the wounded and to provide the necessary medicines. The establishment of mobile pharmacies is regulated by the law of each state and only preparations approved by law can be found in it. There are also regulations for the good storage and warehousing of these drugs.Objective:The aim of this article was to provide an overview of the available literature on the topic “Mobile pharmacies through history”, which shows the development and progress in the structure and function of mobile pharmacies throughout history.Methods:This is an descriptive study based on the searched available literature from the on-line databases regarding to present a historical overview of mobile pharmacies during the most significant war events in Europe and the USA.Results and Discussion:Mobile pharmacies were first mentioned in Egypt and the Roman Empire, but it was not until 1500 that military and ship’s doctors began using them, and wealthy nobles had their own boxes of medicines, which they carried on long voyages. Mobile pharmacies became more and more popular, so in the 18th century, practical manuals on the use of the contents of the box began to be published. The importance of a mobile pharmacy was shown in the wars, where people, before their appearance, died due to the impossibility of providing first aid on the battlefield. The advanced medicine and pharmacy that developed on land, greatly affected the health care at the sea. The constant incidence of infectious diseases, poverty and inadequate nutrition, insecurity of navigation and long voyages are the main reasons why sailors often fell ill and were exposed to injuries at work. A situation like that required that the problem of health protection on ships gets solved in accordance with the then principles of medicine and pharmacy.Conclusion:Authors demonstrated the importance of mobile pharmacies in treating and providing medical protection on boat trips. Regarding the ship’s pharmacies, pharmacists have the role of supplying ships with medicines, conducting training for captains and ship staff, advising shipping companies and captains on equipping ship pharmacies and advising on the preparation of national regulations and national ship pharmacy supply policy.

Challenges Related to Antimalarial Abuse in Coronavirus Disease-2019 Treatment in the Democratic Republic of Congo

Malaria is endemic to many African countries and geographies and remains the leading cause of morbidity and mortality on the continent. Ongoing efforts by health authorities to reverse the scale of malaria are often faced to the challenges of drug resistance often generated by therapeutic abuses relating to self-medication, sub-therapeutic under dosages and poor storage and handling of drugs throughout the pharmacy supply chain system.