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(s): 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. Method(s): 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(s): 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, s, 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. Result(s): The search returned 2365 results. After deduplication, articles were removed at the title (n=1070) (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(s): 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.
ABSTRACT
Introduction:The COVID-19 pandemic has been felt in all areas of health care. We performed a weekly survey amongst the members of the European Society of Oncology Pharmacy (ESOP) to better understand its effects and how they evolved over time. We specifically studied alterations in the care for patients with cancer as well as in the work of oncology pharmacists. Method(s):An online survey was developed by ESOP to compile data about the effects of COVID-19 on the work practices of professionals working in the field of oncology pharmacy. The survey was distributed electronically on a weekly basis from April 6thto June 28th. Result(s):A total of 1146 responses were gathered from respondents in 60 different countries. At any given time point, between 25% and 38% of the respondents had staff infected with COVID-19. In total, 29% of hospital pharmacists reported shortages of drugs necessary for the treatment of COVID-19 patients, and almost 50% also faced shortages of drugs necessary for the treatment of cancer patients. In addition, the majority of hospital pharmacists reported a decrease in planned surgery for oncology patients, as well as a decrease in the amount of chemotherapy preparations. Community pharmacists faced shortages of personal protective equipment in 40% of cases and shortages of drugs in 60%. Conclusion(s):The work of oncology pharmacists both in the clinical setting as well as in the community has been effected profoundly by the COVID-19 pandemic.Copyright © 2021 Lippincott Williams and Wilkins. All rights reserved.
ABSTRACT
BACKGROUND: As with other areas of life, drug markets have been impacted by the COVID-19 pandemic and related restrictions. This article examines how structurally vulnerable people who use drugs (PWUD) experienced and adapted to changes in street drug markets caused by lockdown measures. METHODS: The article builds on ethnographic fieldwork in two Danish cities in 2020, including in-depth interviews with 22 PWUD, and interviews with 20 service providers, including low-threshold service providers and outreach workers. RESULTS: The most consistently reported effect of lockdown measures on local drug markets related to increases in cannabis prices. Accounts of changes in drug availability varied greatly, with some participants reporting changing availability while others described the situation as similar to pre-lockdown conditions. Rather than a long-term drug shortage, changes reported by participants related to the anticipated disruption of local markets and drug scarcity, restrictions in access to cash and sellers seeking to capitalize on the crisis. CONCLUSION: Although no long-term drug scarcity was seen, the anticipation of a shortage was sufficient to impact on local drug market dynamics. Heterogeneity in PWUDs' experiences of access to drug markets during lockdown can to some degree be explained in terms of their varied embeddedness in social networks. While local markets proved resilient to lockdown measures, PWUD less embedded in social networks were more vulnerable to shifts in drug availability and to sellers' over-pricing of drugs.
Subject(s)
COVID-19 , Illicit Drugs , Humans , Droughts , Pandemics , Communicable Disease ControlABSTRACT
Propofol is the preferred anaesthetic for induction and maintenance of sedation in critically ill mechanically ventilated COVID-19 patients. However, during the outbreak of the COVID-19 pandemic, regular supply chains could not keep up with the sudden increase in global demand, causing drug shortages. Propofol is formulated as an oil-in-water emulsion which is administered intravenously. This study explores the extemporaneous preparation of a propofol emulsion without specialized manufacturing equipment to temporally alleviate such shortages. A commercially available lipid emulsion (IVLE, SMOFlipid 20 %), intended for parenteral nutrition, was used to create a propofol loaded nanoemulsion via addition of liquid propofol drug substance and subsequent mixing. Critical quality attributes such as mean droplet size and the volume-weighted percentage of large-diameter (>5µm) droplets were studied. The evolution of droplet size and propofol distribution was monitored in situ and non-destructively, maintaining sterility, using Spatially Resolved Dynamic Light Scattering and Near Infrared Spectroscopy, respectively. Using response surface methodology, an optimum was found for a 4 % w/v propofol formulation with a â¼15 min mixing time in a flask shaker at a 40° shaking angle. This study shows that extemporaneous compounding is a viable option for emergency supply of propofol drug product during global drug shortages.
Subject(s)
COVID-19 , Propofol , Humans , Propofol/chemistry , Emulsions , Pandemics , Parenteral NutritionABSTRACT
The COVID-19 pandemic poses new challenges on pharmaceutical supply chain including the delays and shortages of resources which lead to product backorders. Backorder is a common supply chain problem for pharmaceutical companies which affects inventory management and customer demand. A product is on backorder when the received quantity from the suppliers is less than the quantity ordered. Knowing when a product will be on backorder can help companies effectively plan their inventories, propose alternative solutions, schedule deliveries, and build trust with their customers. In this paper, we investigate two problems. One is how to use machine learning classifiers to predict product backorders for a pharmaceutical distributor. The second problem we focused on is what are the particular challenges and solutions for such task under a pandemic setting. This backorder dataset is different from existing benchmark backorder datasets with very limited features. We discuss our challenges for this task including empirical data pre-processing, feature engineering and understanding the special definitions of backorder under the pandemic situation. We discuss experimental design for predicting algorithm and comparison metrics, and demonstrate through experiments that decision tree algorithm outperforms other algorithms for our particular task. We show through explainable machine learning approaches how to interpret the prediction results. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Worldwide, there is an increase in the shortage of medical supplies due to the global health situation Covid-19. Therefore, it is important to implement methodologies that improve and optimize the management of medical supplies from their purchase, storage and distribution process within these centers. In this sense, the aim of this article is to analyze the relationship between logistics management, the level of supply of medical centers and the level of service provided to patients. Based on this, a study is made of a maternal and child polyclinic in the city of Lima, which has an availability level of 83.51%, which does not reflect an optimal level. Consequently, classification tools are implemented using the ABC-VED matrix and the Inventory Control System. Complementing it with the application of Good Storage Practices and Lean tools such as 5S and Standardization of work to conclude the proposal for improvement in the logistics management of this particular medical center. © 2022 ACM.
ABSTRACT
Drug shortage and inaccessibility, stemming from exorbitant pharmaceutical drug prices, is only but a fraction of the many factors affecting global health. Most recently, the world was reminded of the role of pandemics in fast tracking the above-mentioned problem. A potentially sustainable solution would entail establishing cost effective and efficient local drug manufacture capacity in different regions. Using the HIV/AIDS epidemic as a case example, efforts by various research groups towards this goal are presented herein. © 2022 TeknoScienze. All rights reserved.
ABSTRACT
Background: FarmaFlux is a non-profit organisation providing e-health services to community pharmacists in Belgium. When the pandemic struck a new service was launched to collect relevant data to tackle strategic issues with regard to the COVID-19 crisis. Purpose(s): The COVID-19 Monitor was launched to detect pharmacy activity and drop out. Dispensing volume of relevant medicines was monitored to be able to prevent shortages. Afterwards they were used for outbreak detection and follow up of adherence. Method(s): Professional associations of community pharmacists participated in the national task force 'Shortages' and collected data about dispensing volumes of relevant medicines. Pharmacy activity data were provided at province level. Dispensing data were cross linked with medical data, mobility indicators, financial transactions and absenteeism during the exit phase. Volumes of metformin dispensing were used as an indicator for follow up of chronic treatment. Result(s): Community pharmacy drop out rose up to 3% in early April;but dropped afterwards and gradually went back to normal. Shortages of midazolam and oxygen were the most critical in ambulatory care. They were mitigated by the national task force. Dispensing data were shared with and processed by the federal scientific institution Sciensano. Results of the analysis were shared with the Group of Experts for the Exit Strategy (GEES). Metformin showed a stock piling peak the days before lockdown and an important drop afterwards. Conclusion(s): Dispensing data, collected by FarmaFlux, provided useful information to detect: community pharmacy drop out, medicines shortages in ambulatory care, follow up of adherence and early outbreak detection during the COVID19 crisis.
ABSTRACT
Background: The COVID-19 is a worldwide public health emergency. A possible direct result of this international outbreak is the disruption of medicine supply chains, which may also have consequences in the increase of drug shortages. Community pharmacies can contribute to early identification and report of medicines' supply and demand problems. Purpose(s): The aim of this study is to characterise the impact of COVID-19 on the outpatient medicines' sales and shortages during the initial outbreak Methods: A retrospective, time-trend analysis of medicine sales and shortages was performed from the 1st February to 30th April 2020 and its homologous period. Portuguese daily new laboratory confirmed COVID-19 cases and major national emergency measures were recorded. All data were subjected to rescaling using the min-max normalisation method to become comparable. Data analysis was performed using Microsoft Excel. Result(s): The COVID-19 outbreak resulted in an increased demand for medicines, with a peak reached just after the World Health Organization declaration of the state of pandemic. By the end of March, sales had already dropped to proportions similar to those of 2019. The maximum proportion of drug shortages was reached about one week after the sales peak and by the end of the study period its values were below those recorded in the pre-COVID-19 period. Conclusion(s): Data suggest medicines' sales and shortages were initially impacted by the COVID-19 outbreak in Portugal, although by the end of the study period, medicine markets had normalised. The long-term impacts of this pandemic on medicines' sales and shortages are unknown and should continue to be closely monitored.
ABSTRACT
Background: As one of the most accessible healthcare workers, pharmacists are at the frontlines during emergencies such as the COVID-19 pandemic. Professional pharmacy associations provide resources and recommendations for pharmacists on COVID-19. Yet, the extent and repository of resources are currently not categorised. Purpose(s): To identify COVID-19 resources for pharmacists provided by associations in the United States of America and the International Pharmaceutical Federation (FIP) and characterise these resources to better serve pharmacists' needs to combat the pandemic. Method(s): A review of 17 pharmacy association websites was conducted to identify available resources. Search terms included 'resource, policy and recommendation'. Specific criteria were applied to categorise results in six areas. Descriptive statistics were used for data analysis. Result(s): Of the 16 US pharmacy associations and the FIP websites, 94% provided COVID-19 resources, 53% developed policies, and 94% had specific recommendations. Those were characterised into 6 types of recommendations, including 94% on general recommendations, 65% on education/training, 53% on supply chain management/drug shortages, 47% on guidelines/protocols, 71% on scope of practice, and 24% on the emergence of tele-health. Conclusion(s): Whilst the majority of associations provide COVID-19 related resources on general recommendations, scope of practice, and education/training, there are opportunities for more specific areas on guidelines/protocols and telehealth. With the dynamic nature of COVID-19, it is important for pharmacists to stay updated to provide optimal care for diverse patients and populations while combating the current pandemic and beyond.
ABSTRACT
Objectives: Evaluate the impact of COVID19 on pharmacists' roles and services around the world Methods: A cross-sectional online survey with pharmacists who provided direct patient care during the pandemic. Pharmacists were recruited through social media with assistance from national and international pharmacy organisations. The survey was divided into three sections: 1) demographics, 2) pharmacists' roles and services during the pandemic 3) practice challenges. The data were analysed using SPSS 28, and descriptive statistics were used to report frequencies and percentages. Result(s): A total of 419 pharmacists practicing in 25 countries provided consent to participate. The most common role that pharmacists undertook was responding to drug information requests (90%), followed by allaying patients' fears and anxieties about COVID19 (82.6%), then addressing misinformation about COVID19 treatments and vaccinations (80.4%), and educating the public on strategies to reduce COVID19 transmission (e.g., handwashing) (80.2%). Despite the demands of the pandemic, pharmacists continued to provide clinical services regularly. Managing and/or monitoring patients' chronic diseases was the most frequently provided service (72.6%), followed by treating ambulatory conditions (65.4%), then renewing/extending prescriptions (58%) and prescribing emergency supply refills (52.7%). Interestingly, almost half of the participants reported administering COVID19 vaccines (45.6%). Pharmacists reported being involved in pandemic management through consultations, policy development and participating in taskforces. The most common challenge that pharmacists encountered was increased stress level (84.7%), followed by medication shortages (73.8%), general supply shortages (71.8%), inadequate staffing (69.2%), and concern for the safety of self and others (66.8%). Conclusion(s): Despite the uncertainty, the massive pressure, and the constant need to adapt, pharmacists around the world continued to put the patient first, providing them with highest quality services and making sure that all their needs are met. Pharmacists are definitely the unsung heroes of pandemic and their actions should cement their place as an essential health service.
ABSTRACT
Opportunistic infections, such as mucormycosis, in coronavirus disease 2019 (COVID-19) patients has become a new health challenge. Since opportunistic infections can exacerbate COVID-19 patients' status, it is vital to identify the risk factors to prevent, diagnose, and treat them as soon as possible. Viral, fungal, environmental, and host factors may be responsible for this situation. Long hospital stays, impaired host immune system function due to viral infection, and excessive consumption of glucocorticoids in managing COVID-19 patients are the main risk factors for the increased risk of mucormycosis in COVID-19 patients. Educating health care workers and considering the association between mucormycosis of the paranasal sinuses and different strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the cause of COVID-19 can help prevent invasive fungal sinusitis in COVID-19 patients. Copyright © 2021, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
ABSTRACT
INTRODUCTION: Tocilizumab has been shown to decrease mortality when used concomitantly with steroids in COVID-19. Tocilizumab dose of 8 mg/kg (max: 800 mg), stemmed from the RECOVERY trial, has been the standard dose for COVID. Due to a drug shortage of tocilizumab, our study seeks to assess whether low dose (400 mg) shows similar benefit compared to high dose for COVID patients concurrently on same median dose of steroids. METHOD(S): This was a retrospective observational study of COVID-19 patients who received tocilizumab in conjunction with steroids. Between March 2020 and August 2021, adult patients with positive COVID-19 PCR, hypoxic respiratory failure defined as FiO2>70%, and received a dose of tocilizumab in conjunction with steroids were included. Patients were excluded if they have died within 24 hours of treatment initiation. Primary outcome was 28-day mortality and secondary outcomes included biomarker improvement and relative risk of infection. Propensity matched analysis between groups was performed. RESULT(S): A total of 407 patients met the study criteria and were analyzed. The low dose and high dose tocilizumab group had 222 and 185 patients respectively. Gender and age were similar between groups and all patients received steroids. The low dose group was significantly more ill at baseline as a higher percentage of patients received vasopressors, were admitted to the ICU and on mechanical ventilation. In the propensity-matched analysis of 56 patients in each group, with a median dose of steroid of 10 mg in both groups showed no difference in 28 day mortality (HR 0.82 [95% CI: 0.41-1.67];p=0.6138). A greater decrease to normalization of CRP (p< 0.0001) and downtrend of ferritin (p=0.503) was observed in the high dose group at day 14. The high dose group trended a higher rate of fungal and viral infections. CONCLUSION(S): Compared to low dose tocilizumab, high dose did not provide additional efficacy and mortality benefit but resulted in uptrend of fungal and viral infections. While a greater decrease in CRP was seen in the high dose group, it did not translate into lower mortality. This study illustrates that low dose tocilizumab can be an alternative to high dose during a drug shortage of tocilizumab without compensating for efficacy and safety, conserving resources for more patients.
ABSTRACT
INTRODUCTION: Increased use of sedatives and analgesics has been noted in patients with COVID-19 causing an increase in drug shortages. This study quantified sedative and analgesic requirements pre-COVID and during a COVID surge month. METHOD(S): This retrospective, single-center, cohort study included adult patients admitted to an ICU during January 2020, prior to the COVID-19 pandemic and January 2021, our local surge. Drugs that were examined were propofol, midazolam, dexmedetomidine and fentanyl. Continuous infusion and bolus doses were quantified whereby cumulative drug administered, frequency of use, average dose and duration of therapy were compared for each month (pre- COVID and COVID surge). RESULT(S): There were 454 patients included: pre-COVID, n=262;COVID, n=192. During the COVID surge, more patients required mechanical ventilation (32% vs. 52%, p< 0.001) and renal replacement therapy (5% vs. 14%, p=0.001). During the COVID surge, midazolam requirements were 362% higher (14,682 vs. 53,128 mg) which was due to greater frequency (26% vs. 41%, p=0.001) and longer duration of use (36 [7-55] vs. 59 [20-124] h, p=0.015). The median dose was not different (4.5 [3-9] vs. 5.6 [3-9] mg/h, p=0.577). Dexmedetomidine requirements were 126% higher (97,721 vs. 123,806 mg). This was due to greater frequency (22% vs. 33%, p=0.006) and longer duration of use (14 [4-46] vs. 34 [12-60] h, p=0.32). The median dose was not different (0.4 [0.2-0.8] vs. 0.4 [0.2-0.8] mcg/kg/h, p=0.954). Fentanyl requirements were 352% higher (286,742 vs. 1,009,563 mcg). This was due to greater frequency (38% vs. 55%, p< 0.001) and longer duration of use (28 [11-74] vs. 58 [16-127] h, p=0.017). The median dose was not different (59 [47-116] vs. 87 [53-141] mcg/h, p=0.071). Conversely, the use of propofol was 22% less (469 vs. 364 g). There was no difference between the frequency of use (20% vs. 27%, p=0.087), duration of use (18 [6-59] vs. 20 [8-50] h, p=0.97) or median dose (34 [21-60] vs. 35 [20-63] mcg/kg/min, p=0.947). CONCLUSION(S): Sedative and analgesic use increased by more than 300% for some drugs during the COVID surge. This was primarily due to greater frequency of use and longer durations of therapy. Clinicians must consider these factors when planning for future surges to minimize drug shortages.
ABSTRACT
Objectives: To identify stakeholders' understanding of drug shortage and the internal process of reporting a drug shortage to the Saudi Food & Drug Authority (SFDA). Evaluate the clarity of the communication channels and the stakeholder's satisfaction. A secondary objective was to explore the impact of COVID-19 on drug shortage in Saudi Arabia. Method(s): A cross-sectional study consisting of three separate surveys targeting: Health care providers, National Unified Procurement Company (NUPCO) registered in Saudi-vigilance, and pharmaceutical companies/storage that are registered in (RSD). Descriptive analysis such as percentages and frequencies was preformed to describe the knowledge and the practice of the targeted stakeholders Results: Drug shortages was defined by healthcare institutions as the unavailability of the product in the agent's stocks and by NUPCO as zero stock, and confirmation by pharmaceutical companies of product unavailability. Positive Feedback on drug availability services;55% supplying agents compliance, 69% drug availability improvement and 89% SFDA contribution to facilitate drug availability. Satisfaction on reporting system was reported by (47%) of healthcare institutions and (43%) of pharmaceutical companies' .COVID-19 pandemic impact on drug shortages: Most pharmaceutical company identified highest impact on different medication groups (39.7%) and antibiotics (22.2%). Most Healthcare institutions identified highest impact on antiviral medications (80%). Conclusion(s): Most of the stakeholders had a positive feedback and satisfaction rate on services of SFDA drug availability department. For the COVID-19, as expected, COVID-19 had a noticeable impact on drug shortages and demands in Saudi Arabia. Copyright © 2022