Drug and others products shortage in Brazilian health services in the scenario imposed by COVID-19
DOI:
https://doi.org/10.33448/rsd-v11i5.27928Keywords:
COVID-19; Health Services; Pharmaceutical Services; Surveys and questionnaires.Abstract
Objective: We aimed at investigating and describing the drug and material resources in health shortage in the Brazilian services during the COVID-19 pandemic. Methods: We conducted a cross-sectional study in the format of an online survey with closed questions. Information was sought about the institutional and care profile, pharmaceutical service organization, non-compliance in the stock, or lack of drugs and other health products between April and October 2020. We performed descriptive, univariate, and multivariate statistical analyses, such as Fisher's t-test, chi-square test, and the Multiple Correspondence and Hierarchical Cluster analyses. A p-value below 0.05 and a 95% significance level were considered. Results: 228 Brazilian institutions, most located in the capital cities, with specific beds for COVID-19 and public administration, were included in the study. Grouping by similarity separated the study sample into five heterogeneous clusters. Eighty-four percent of the services indicated a drugs shortage, especially neuromuscular blocking agents (64.9%), hypnotics and sedatives (52.9%), vasoactive drugs (37.3%), and antiinfective agents (30%). Conclusion: In all the clusters, there were reports of a shortage of items considered essential in the management of critically-ill patients, corroborating the perception that this was a significant challenge for pharmaceutical assistance in various Brazilian services during the COVID-19 pandemic.
References
Abdi, H., & Valentin, D. (2007). Multiple Correspondence Analysis. Encyclopedia of Measurement and Statistics.
Acosta, A., Vanegas, E. P., Rovira, J., Godman, B., & Bochenek, T. (2019). Medicine Shortages: Gaps Between Countries and Global Perspectives. Frontiers in Pharmacology, 10, 763. https://doi.org/10.3389/fphar.2019.00763
African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators. (2021). Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): A multicentre, prospective, observational cohort study. Lancet (London, England), 397(10288), 1885–1894. https://doi.org/10.1016/S0140-6736(21)00441-4
Agência Nacional de Vigilância Sanitária. (2021, janeiro 18). Painel mostra dados sobre medicamentos para Covid-19. Agência Nacional de Vigilância Sanitária - Anvisa. https://www.gov.br/anvisa/pt-br/assuntos/noticias-anvisa/2020/painel-mostra-dados-sobre-medicamentos-para-covid-19
Aljadeed, R., AlRuthia, Y., Balkhi, B., Sales, I., Alwhaibi, M., Almohammed, O., Alotaibi, A. J., Alrumaih, A. M., & Asiri, Y. (2021). The Impact of COVID-19 on Essential Medicines and Personal Protective Equipment Availability and Prices in Saudi Arabia. Healthcare, 9(3), 290. https://doi.org/10.3390/healthcare9030290
AlRuthia, Y. S., AlKofide, H., AlAjmi, R., Balkhi, B., Alghamdi, A., AlNasser, A., Alayed, A., Alshammari, M., Alsuhaibani, D., & Alathbah, A. (2017). Drug shortages in large hospitals in Riyadh: A cross-sectional study. Annals of Saudi Medicine, 37(5), 375–385. https://doi.org/10.5144/0256-4947.2017.375
American Society of Health-System Pharmacists. (2021). Drug Shortages Statistics—ASHP. https://www.ashp.org/Drug-Shortages/Shortage-Resources/Drug-Shortages-Statistics
Ayati, N., Saiyarsarai, P., & Nikfar, S. (2020). Short and long term impacts of COVID-19 on the pharmaceutical sector. DARU Journal of Pharmaceutical Sciences, 28(2), 799–805. https://doi.org/10.1007/s40199-020-00358-5
Badreldin, H. A., & Atallah, B. (2021). Global drug shortages due to COVID-19: Impact on patient care and mitigation strategies. Research in Social & Administrative Pharmacy, 17(1), 1946–1949. https://doi.org/10.1016/j.sapharm.2020.05.017
Bohand, X., Jordan, D., & Dubois, F. (2021). Managing the risk of shortages and medication errors with curares during the COVID-19 pandemic: A hospital pharmacy experience. European Journal of Hospital Pharmacy, ejhpharm-2020-002605. https://doi.org/10.1136/ejhpharm-2020-002605
Botega, L. de A., Andrade, M. V., Guedes, G. R., Botega, L. de A., Andrade, M. V., & Guedes, G. R. (2020). Perfil dos hospitais gerais do Sistema Único de Saúde. Revista de Saúde Pública, 54. https://doi.org/10.11606/s1518-8787.2020054001982
Cadastro Nacional de Estabelecimentos de Saúde. (2021, abril 10). http://cnes.datasus.gov.br/
Cameron, E. E., & Bushell, M.-J. A. (2021). Analysis of drug shortages across two countries during pre-pandemic and pandemic times. Research in Social and Administrative Pharmacy, 17(9), 1570–1573. https://doi.org/10.1016/j.sapharm.2020.12.001
Carvalho, M. S., & Struchiner, C. J. (1992). Análise de correspondência: Uma aplicação do método à avaliação de serviços de vacinação. Cadernos de Saúde Pública, 8(3), 287–301. https://doi.org/10.1590/S0102-311X1992000300008
Castro, M. C., Kim, S., Barberia, L., Ribeiro, A. F., Gurzenda, S., Ribeiro, K. B., Abbott, E., Blossom, J., Rache, B., & Singer, B. H. (2021). Spatiotemporal pattern of COVID-19 spread in Brazil. Science. https://doi.org/10.1126/science.abh1558
Castro, M. C., Massuda, A., Almeida, G., Menezes-Filho, N. A., Andrade, M. V., Noronha, K. V. M. de S., Rocha, R., Macinko, J., Hone, T., Tasca, R., Giovanella, L., Malik, A. M., Werneck, H., Fachini, L. A., & Atun, R. (2019). Brazil’s unified health system: The first 30 years and prospects for the future. The Lancet, 394(10195), 345–356. https://doi.org/10.1016/S0140-6736(19)31243-7
Chaves, G. C., Moraes, E. L., & Osorio-de-Castro, C. G. S. (2021). Estratégias de produção e aquisição de produtos farmacêuticos em contexto de dependência. Cadernos de Saúde Pública, 37(3), e00036821. https://doi.org/10.1590/0102-311x00036821
Clews, G. (2021, março 27). Manufacturing problems cause 60% of medicines shortages, say European wholesalers. The Pharmaceutical Journal. https://pharmaceutical-journal.com/article/news/manufacturing-problems-cause-60-of-medicines-shortages-say-european-wholesalers
Commissioner, O. of the. (2020, setembro 9). Food and Drug Administration. FDA; FDA. https://www.fda.gov/consumers/consumer-updates/combating-antibiotic-resistance
Cundell, T., Guilfoyle, D., Kreil, T. R., & Sawant, A. (2020). Controls to Minimize Disruption of the Pharmaceutical Supply Chain During the COVID-19 Pandemic. PDA Journal of Pharmaceutical Science and Technology, 74(4), 468–494. https://doi.org/10.5731/pdajpst.2020.012021
Don Eliseo Lucero-Prisno, I. I. I., Elhadi, Y. A. M., Modber, M. A. A., Musa, M. B., Mohammed, S. E. E., Hassan, K. F., Dafallah, A., Lin, X., Ahmadi, A., Adeyemi, S., Ekpenyong, A., & Adebisi, Y. A. (2020). Drug shortage crisis in Sudan in times of COVID-19. Public Health in Practice, 1, 100060.
European Medicines Agency. (2018, setembro 17). Availability of medicines [Text]. European Medicines Agency. https://www.ema.europa.eu/en/human-regulatory/post-authorisation/availability-medicines
Everitt, B., & Dunn, G. (2001). Applied multivariate data analysis. Arnold ; Oxford University Press.
FenaSaúde. (2021). Covid-19 causa aumento de até de 5.275% nos custos dos planos de saúde com medicamentos de intubação | FenaSaude. https://fenasaude.org.br/noticias/covid-19-causa-aumento-de-ate-de-5-275-nos-custos-dos-planos-de-saude-com-medicamentos-de-intubacao.html
Fernandes, D. R. A., Gadelha, C. A. G., & Maldonado, J. M. S. de V. (2021). Vulnerabilidades das indústrias nacionais de medicamentos e produtos biotecnológicos no contexto da pandemia de COVID-19. Cadernos de Saúde Pública, 37(4), e00254720. https://doi.org/10.1590/0102-311x00254720
Ferrando, C., Suarez-Sipmann, F., Mellado-Artigas, R., Hernández, M., Gea, A., Arruti, E., Aldecoa, C., Martínez-Pallí, G., Martínez-González, M. A., Slutsky, A. S., & Villar, J. (2020). Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Medicine, 1–12. https://doi.org/10.1007/s00134-020-06192-2
Food and Drug Administration, O. of the. (2021, outubro 25). U.S. Food and Drug Administration. FDA; FDA. https://www.fda.gov/home
Fox, E. R., Birt, A., James, K. B., Kokko, H., Salverson, S., Soflin, D. L., & Soflin, D. L. (2009). ASHP Guidelines on Managing Drug Product Shortages in Hospitals and Health Systems. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 66(15), 1399–1406. https://doi.org/10.2146/ajhp090026
Greenacre, M., & Hastie, T. (1987). The Geometric Interpretation of Correspondence Analysis. 12.
Hoss, M., & Caten, C. S. ten. (2010). Processo de Validação Interna de um Questionário em uma Survey Research Sobre ISO 9001:2000. Produto & Produção, 11(2), Article 2. https://doi.org/10.22456/1983-8026.7240
IBGE | Biblioteca | Detalhes | L’Analyse des donnees / rediges et publies sous la direction du Professeur J. P. Benzecri. -. (2021, janeiro 18). https://biblioteca.ibge.gov.br/biblioteca-catalogo.html?id=222708&view=detalhes
Jager, J., Putnick, D. L., & Bornstein, M. H. (2017). More than Just Convenient: The Scientific Merits of Homogeneous Convenience Samples. Monographs of the Society for Research in Child Development, 82(2), 13–30. https://doi.org/10.1111/mono.12296
Martinez, E. Z., Aragon, D. C., Nunes, A. A., Martinez, E. Z., Aragon, D. C., & Nunes, A. A. (2020). Long-term forecasts of the COVID-19 epidemic: A dangerous idea. Revista Da Sociedade Brasileira de Medicina Tropical, 53. https://doi.org/10.1590/0037-8682-0481-2020
Melo, A. C., Galato, D., Maniero, H. K., Frade, J. C. Q. P., Palhano, T. J., Silva, W. B. da, & João, W. da S. J. (2017). Pharmacy in Brazil: Progress and Challenges on the Road to Expanding Clinical Practice. Canadian Journal of Hospital Pharmacy, 70(5), Article 5. https://doi.org/10.4212/cjhp.v70i5.1700
Merchan, C., Soliman, J., Ahuja, T., Arnouk, S., Keeley, K., Tracy, J., Guerra, G., DaCosta, K., Papadopoulos, J., & Dabestani, A. (2020). COVID-19 pandemic preparedness: A practical guide from an operational pharmacy perspective. American Journal of Health-System Pharmacy: AJHP. https://doi.org/10.1093/ajhp/zxaa212
Miljković, N., Godman, B., Kovačević, M., Polidori, P., Tzimis, L., Hoppe-Tichy, T., Saar, M., Antofie, I., Horvath, L., De Rijdt, T., Vida, R. G., Kkolou, E., Preece, D., Tubić, B., Peppard, J., Martinez, A., Yubero, C. G., Haddad, R., Rajinac, D., … Miljković, B. (2020). Prospective Risk Assessment of Medicine Shortages in Europe and Israel: Findings and Implications. Frontiers in Pharmacology, 11. https://doi.org/10.3389/fphar.2020.00357
Ministério da Saúde. (2018). Assistência Farmacêutica no SUS: 20 anos de políticas e propostas para desenvolvimento e qualificação: Relatório com análise e recomendações de gestores, especialistas e representantes da sociedade civil organizada [recurso eletrônico] (p. 127).
Nascimento, A. do, Almeida, R. M. V. R., Castilho, S. R. de, & Infantosi, A. F. C. (2013). Análise de correspondência múltipla na avaliação de serviços de farmácia hospitalar no Brasil. Cadernos de Saúde Pública, 29(6), 1161–1172. https://doi.org/10.1590/S0102-311X2013000600013
Oliveira, Ely Francina Tannuri; Grácio, Maria Claudia Cabrini. (2022). Análise a respeito do tamanho de amostras aleatórias simples: Uma aplicação na área de Ciência da Informação. https://brapci.inf.br/index.php/res/v/6591
Omer, S., Pan, M., Ali, S., Shukar, S., Fang, Y., & Yang, C. (2021). Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: Findings from a cross-sectional survey. BMJ Open, 11(12), e050196. https://doi.org/10.1136/bmjopen-2021-050196
Palomar-Fernández, C., & Álvarez-Díaz, A. (2020). Hospital Pharmacy Service: Facing the logistics of medicines procurement. Farmacia Hospitalaria: Organo Oficial De Expresion Cientifica De La Sociedad Espanola De Farmacia Hospitalaria, 44(7), 17–20. https://doi.org/10.7399/fh.11489
Passos, M. M. B. dos, Castoldi, V. de M., & Soler, O. (2021). O papel do farmacêutico na pandemia de COVID-19: Revisão integrativa. Research, Society and Development, 10(6), Article 6. https://doi.org/10.33448/rsd-v10i6.15809
Paumgartten, F. J. R., & Oliveira, A. C. A. X. de. (2020). Off label, compassionate and irrational use of medicines in Covid-19 pandemic, health consequences and ethical issues. Ciência & Saúde Coletiva, 25(9), 3413–3419. https://doi.org/10.1590/1413-81232020259.16792020
Pauwels, K., Huys, I., Casteels, M., & Simoens, S. (2014). Drug shortages in European countries: A trade-off between market attractiveness and cost containment? BMC Health Services Research, 14(1), 438. https://doi.org/10.1186/1472-6963-14-438
Pauwels, K., Simoens, S., Casteels, M., & Huys, I. (2015). Insights into European Drug Shortages: A Survey of Hospital Pharmacists. PLOS ONE, 10(3), e0119322. https://doi.org/10.1371/journal.pone.0119322
Pulk, R. A., Leber, M., Tran, L., Ammar, M., Amin, N., Miller, L., & Yazdi, M. (2020). Dynamic pharmacy leadership during the COVID-19 crisis: Optimizing patient care through formulary and drug shortage management. Am J Health Syst Pharm, 1874–1884.
Reis, A. M. M., & Perini, E. (2008). Desabastecimento de medicamentos: Determinantes, conseqüências e gerenciamento. Ciência & Saúde Coletiva, 13(suppl), 603–610. https://doi.org/10.1590/S1413-81232008000700009
Rosa, M. B., Reis, A. M. M., & Perini, E. (2016). Drug shortage: A public health problem. Cadernos de Saúde Pública, 32(10). https://doi.org/10.1590/0102-311X00086916
Schweitzer, S. O. (2013). How the US Food and Drug Administration Can Solve the Prescription Drug Shortage Problem. American Journal of Public Health, 103(5), e10–e14. https://doi.org/10.2105/AJPH.2013.301239
Secretaria de Governo. (2021). Financiamento na Saúde. Secretaria de Governo. https://www.gov.br/secretariadegoverno/pt-br/portalfederativo/agenda-do-prefeito-brasil/guia-prefeito-200-dias/conteudos-e-orientacoes/saude
Sen-Crowe, B., Sutherland, M., McKenney, M., & Elkbuli, A. (2021). A Closer Look Into Global Hospital Beds Capacity and Resource Shortages During the COVID-19 Pandemic. The Journal of Surgical Research, 260, 56–63. https://doi.org/10.1016/j.jss.2020.11.062
Shortages catalogue | European Medicines Agency. (2021). https://www.ema.europa.eu/en/human-regulatory/post-authorisation/availability-medicines/shortages-catalogue
Shukar, S., Zahoor, F., Hayat, K., Saeed, A., Gillani, A. H., Omer, S., Hu, S., Babar, Z.-U.-D., Fang, Y., & Yang, C. (2021). Drug Shortage: Causes, Impact, and Mitigation Strategies. Frontiers in Pharmacology, 12, 1772. https://doi.org/10.3389/fphar.2021.693426
Silva, L. M. C. da, & Araújo, J. L. (2020). Atuação do farmacêutico clínico e comunitário frente a pandemia da COVID-19. Research, Society and Development, 9(7), e684974856–e684974856. https://doi.org/10.33448/rsd-v9i7.4856
Sociedade Brasileira de Farmácia Hospitalar. (2021, abril 21). Levantamento nacional sobre o abastecimento de medicamentos e produtos para a saúde durante o enfrentamento da pandemia pela Covid-19. http://www.sbrafh.org.br/inicial/levantamento-nacional-referente-ao-abastecimento-de-medicamentos-e-produtos-para-a-saude-durante-o-enfrentamento-da-pandemia-pela-covid-19-anexo-do-oficio-no-037-2020-enviado-ao-ministro-da-saude-em/
Ventola, C. L. (2011). The Drug Shortage Crisis in the United States. Pharmacy and Therapeutics, 36(11), 740–757.
Videau, M., Chemali, L., Stucki, C., Saavedra-Mitjans, M., Largana, S., Guerin, A., Bonnabry, P., Delhauteur, B., Hees, T. V., Lebel, D., & Bussières, J.-F. (2019). Drug Shortages in Canada and Selected European Countries: A Cross-Sectional, Institution-Level Comparison. Canadian Journal of Hospital Pharmacy, 72(1), Article 1. https://doi.org/10.4212/cjhp.v72i1.2863
Vogler, S., & Fischer, S. (2020). How to address medicines shortages: Findings from a cross-sectional study of 24 countries. Health Policy (Amsterdam, Netherlands), 124(12), 1287–1296. https://doi.org/10.1016/j.healthpol.2020.09.001
Wallis, N., Gust, C., Porter, E., Gilchrist, N., & Amaral, A. (2020). Implementation of field hospital pharmacy services during the COVID-19 pandemic. American Journal of Health-System Pharmacy: AJHP. https://doi.org/10.1093/ajhp/zxaa211
World Health Organization. (2016). Meeting Report: Technical Definitions of Shortages and Stockouts of Medicines and Vaccines.
World Health Organization. (2021, abril 10). WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int
Ying, W., Qian, Y., & Kun, Z. (2020). Drugs supply and pharmaceutical care management practices at a designated hospital during the COVID-19 epidemic. Research in Social & Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2020.04.001
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