Tiago Villanueva: Shortages of medicines in Europe are having a impact on primary care

tiago_villanuevaThe shortage of medicines in Europe is an increasing problem. Recently I attended a workshop at the European Medicines Agency which convened stakeholders from the pharmaceutical industry, European national medicines agencies, patient organisations, and healthcare professionals to discuss the issue. I was there as a representative of GPs in Europe, to give a perspective of how GPs on the frontline of clinical practice are dealing with the increasingly frequent scenario of unavailable medicines.The discussion was part of a panel discussing how much information on the availability of medicines is provided by national medicines agencies. 

Yngvil Knudsen, from the Norwegian Medicines Agency, presented a survey of 30 medicines agencies across the European Union and European Economic Area, which looked at their public communication practices on the shortage of medicines. Even though about 90% of agencies claim that they publish information about shortages of medicines on their websites, the information is not necessarily easy to find. Ireland’s Health Products Regulatory Authority stands out as a good example of how information about shortages of medicines can be found quickly, and presented clearly on their homepage.

I also raised concerns that national medicines agencies may not be targeting GP’s preferred sources of information. For instance, the survey showed that only 7% and 23% of agencies provide information through electronic prescribing systems and social media, respectively. I told the audience that in my own practice, I usually find out about shortages of medicines when I realise that I can’t find a certain drug on my own electronic prescribing system, and most of the time that happens when I have a patient in front of me, which can cause considerable frustration to both of us. Online medicines formularies that could be updated in real time are another tool that has the potential to convey information about medicines shortages, because GPs use them on a daily basis and at the point of care.

Even though GPs can’t solve the actual problem of medicines shortages (which may relate, for example, to a disruption in the manufacturing or the supply chain), we are responsible for prescribing an alternative medicine. I told attendees that it would be extremely useful if national agencies could move beyond just providing information on medicines shortages and also provide information on alternatives that offer the greatest benefits with the lowest risk, in order to inform clinical decision making. Switching a patient’s medicines may carry significant risk, particularly in vulnerable groups like older people. Apart from the risk of drug interactions, adverse drug reactions, over or under-dosing, there is also a potential psychological impact, for example when patients refuse to switch and decide not to take any medicine. There are possibly even repercussions for public health, for example an increase in antimicrobial resistance if we are forced to prescribe broader spectrum antibiotics.

My final message was that we should ideally learn about medicines shortages before they actually occur. This would allow for GPs to plan alternative strategies, for example, providing longer-term refills of medicines (for example 1 year instead of 3 to 6 months), even though, as one attendee pointed out, this could potentially deplete stocks of medicine more quickly.

There are no quick solutions to medicines shortages. It is a complex issue which will require the ongoing collaboration of all stakeholders. Information about shortages needs to become more harmonised across the different European countries, and more visible and easily accessible.

Tiago Villanueva is a GP in the Portuguese National Health Service and vice-president elect of the European Union of General Practitioners / Family Physicians. He is also an associate editor, The BMJ.

Competing interests: His travel expenses to the workshop were covered by the European Medicines Agency.