Most GPs discover medication shortages through patients: Poll

Almost three in every four newsGP readers say they are most likely to learn about medication shortages through their patients, according to the results of a new poll.
 
In the survey, which ran on newsGP earlier this month, the overwhelming majority of the 1459 respondents (73%) said patients are the most common way they learn of shortages, with pharmacists and media reports the next most likely sources at 11% each.
 
The Therapeutic Goods Administration (TGA) and manufacturers accounted for just 2% and 1% respectively. 
 
The results are another sign of the significant challenges facing the TGA as it seeks more ways to communicate and mitigate the impact of medication shortages.
 
According to the TGA’s medicine shortages report database, there are currently 427 shortages of reportable medicines in Australia, including 35 critical shortages.  
 
For GPs, the results of the newsGP survey may be disappointing but they reflect well known inadequacies.
 
‘It’s often hard to keep up as a GP – or any other practitioner – with which medications are in shortage, and for what reasons,’ Sydney GP Dr Michael Bonning told newsGP.  
 
‘Patients shouldn’t have to be a pathway for informing GPs of shortages of medications.’
 
For Dr Michael Tam, a member of the RACGP Expert Committee – Quality Care, the results are also not unexpected.
 
‘In some ways, it doesn’t surprise me that we will hear of a shortage first from our patients, because that would be the most direct mechanism,’ he told newsGP.
 
Like Dr Bonning, he points to the deluge of information that GPs receive every day, and also highlights the challenges of communicating shortages that can vary significantly across regions and even different local pharmacies.
 
‘There may be an overall national shortage, but pockets … with access, then in other areas it becomes really difficult to find,’ he said.
 
‘That local intelligence is really important, and it would be hard to imagine a national-type organisation would be aware of that sort of stuff.’
 
With increasing public awareness of medication shortages, the TGA launched an inquiry last February to consider how to reduce their impact as well as to improve communication with healthcare professionals.
 
Last November, it released proposals to add 23 non-prescription medicines to the list of reportable medicines, noting previous shortages affecting intravenous (IV) fluids, permethrin, along with contrast agents for medical imaging and radiopharmaceuticals
 
It also proposes requiring sponsors to give 12 months’ notice of any decision to discontinue the supply of a reportable medicine, rather than for just those deemed likely to be of critical impact.
 
The TGA says the proposals are part of its ‘initial focus’ on actions ‘to better meet public information needs’.
 
Improvements to data and digital infrastructure as well as access to information for health professionals are also on the table, according to the TGA – but its ‘initial focus’ is on measures ‘to better meet public information needs’.
 
For Dr Bonning, who is Deputy Chair of RACGP Expert Committee – Funding and Health System Reform, technology will be key to improving communication.
 
‘One of the potential ways forward here is for a collaborative effort between the TGA, medication suppliers and practice management software to provide online, in-practice management, software advice regarding discontinuations and supply,’ he said.
 
He highlights the current lack of cross-platform communication, giving a recent example affecting the supply of several medications containing estrogen.
 
‘Recently, six of the seven preparations that are listed as available in Australia are in shortage,’ he said.
 
‘So you’re suddenly in this situation of not being able to provide good advice, but those medications are still listed normally in our practice management software.’
 
Both Drs Tam and Bonning also raised supply chain issues, citing limited Australian manufacturing of essential medications.
 
They advocated for increasing domestic manufacturing capacity to mitigate those risks.
 
‘There is a systems-based communication issue, but then there is also a pharmaceutical sovereignty issue that Australia can reasonably address over the coming years,’ Dr Bonning said.
 
On the communication of shortages, Dr Bonning emphasises the importance of streamlining processes so patients and GPs are not caught out.
 
For him, the challenges presented by carrying on with the status quo with patients often informing GPs of shortages, are reputational as well as clinical.
 
‘In the end, I think that also undermines confidence in our knowledge of the system, even though that is information that is not readily available to us in day-to-day clinical practice,’ Dr Bonning said.
 
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