Addressing Drug Shortages at Mediclinic Parkview Hospital: A ‎Five-Year Study of ‎Challenges, Impact, and Strategies

Abstract

Background Drug shortages have become a significant challenge globally, affecting healthcare delivery and patient outcomes. This study aimed to assess drug shortages' prevalence, causes, and impact at a tertiary care hospital in Dubai, the United Arab Emirates (UAE), providing actionable insights for future mitigation strategies. Methods A retrospective descriptive study was conducted at Mediclinic Parkview (MPAR) Hospital, part of Mediclinic Middle East (MCME), UAE. Data were collected from January 2019 to December 2023. Reported drug shortages were analyzed to assess their frequency, duration, causes, and management, with a focus on identifying trends and underlying factors. Results Drug shortages peaked at 995 in 2020, particularly during the COVID-19 pandemic. The median time spent managing shortages reached 19.5 days per shortage in Q3 2020. Oral forms accounted for the highest frequency (n = 2231), representing 61% of all shortages, followed by topical forms (n = 414, 11%) and injection forms (n = 386, 10%). Most affected drugs were in the infectious disease (n = 547, 15%), cardiovascular (n = 387, 11%), and respiratory (n = 330, 9%) categories. Drug shortages were driven by regulatory issues and manufacturing delays (39%), unknown reasons (29%), and supply chain disruptions exacerbated by the pandemic (10%). A monopoly environment worsened the situation and limited sourcing flexibility, with 66% of shortages linked to zero supply competitors. Tirzepatide (n = 20) and oseltamivir (n = 18) were the drugs most frequently reported to be unavailable over the 60-month study interval. Regarding management efforts, 80% of the time was spent gathering information and communicating with the different stakeholders. The hospital's response included contacting prescribers for alternatives and increased reliance on internal procurement and inter-pharmacy coordination. These shortages caused significant operational strain, with increased workloads and higher costs. Conclusion The study highlighted the need for adopting proactive measures, improved strategies, enhanced communication, and better preparedness to address future drug shortages. Key actions involved investing in technology, strengthening supplier relationships, and advocating for policy reforms to mitigate risks and ensure continuity of care.

Keywords: drug shortages; hospital pharmacy; medication management; mediclinic middle east; operational efficiency; pharmaceutical supply chain; policy reforms; risk management; strategies.

Figure 1. Active drug shortages per year (2019-2023)‎

Figure 2. Active drug shortages per quarter (2019-2023)‎

Figure 3. Distribution of medicine forms affected by shortages (2019-2023)‎

IUD, intrauterine device

Figure 4. British National Formulary (BNF) drug classes impacted by shortages (2019-2023)‎

Figure 5. Fishbone diagram describing root causes of drug shortages

GMP, good manufacturing practices; API, active pharmaceutical ingredient; COVID-19, coronavirus disease 2019 Image content credit: Dr. Mohammed Sallam

Figure 6. Yearly notifications about drug shortages

MCME, Mediclinic Middle East

Figure 7. Processes used for managing prescriptions during drug shortages

MCME, Mediclinic Middle East

Figure 8. Drug shortages and their impact on the medication use process (2019-2023)‎

Figure 9. Trends in drug shortages temporary vs. permanent (2019-2023)‎

Drug shortages can manifest as temporary delays in drug availability or permanent drug discontinuations. Temporary drug shortages are situations where the supply of medication is temporarily insufficient to meet the demand or projected demand within a specific timeframe. These shortages are typically resolved once the underlying issues are addressed. Permanent drug shortages, also known as drug discontinuations, occur when a manufacturer permanently stops producing a specific medication. These shortages are more challenging to address and may require finding alternative treatments or sourcing the drug from different manufacturers.

Figure 10. Top reasons driving drug shortages

COVID-19, coronavirus disease 2019

Figure 11. Market competition types contributing to drug shortages

Monopoly: A market structure where a single company or entity is the sole provider of a particular product or service, meaning no competitors exist. Oligopoly: A market structure characterized by a small number of firms or competitors that dominate the market. Duopoly: A market structure where only two firms or suppliers control the market for a particular product or service.

Figure 12. Percentage of task distribution for managing drug shortages

Figure 13. Percentage ‎of time spent by the pharmacy team in managing shortage management

Figure 14. Top 10 drugs with supply disruptions and shortage frequency over 60 months

Figure 15. Top 10 costly drug shortages