Managing medicine shortages in community pharmacies: a simulated patient mixed-method study

Medicine shortages are a global challenge that negatively affects patients' outcomes. In pharmacies, shortages have financial and time-consuming consequences, pose patient safety risks, and require high-quality management.

To 1) evaluate the quality of medicine shortage management based on a pharmacy practice standard, 2) assess pharmacist-patient communication during shortages, and 3) explore pharmacists' reflections after feedback.

A mixed-method study was conducted using simulated patient (SP) visits with feedback and qualitative interviews. SP visited 46 community pharmacies in Norway with prescriptions for medicines in shortage (ranitidine and varenicline). Consultations were audio-recorded, transcribed and analyzed by deductive content analysis. Pharmacists were offered feedback and invited to interviews, that was audio recorded and transcribed. Data was analyzed by inductive content analysis.

Regarding the quality of shortage management, pharmacists adhered to selected elements of the practice standard, particularly checking availability of alternatives in-house (83.7%) or nearby pharmacies (88.4%) and considering prescriber contact (81.4%). However, few assessed patients' remaining supply (7.0%), and none provided written information. Communication during shortage consultations was largely inadequate, although information on the cause and expected duration of shortages was frequently given (76.7% and 97.7%, respectively). Pharmacists' reflections revealed variable familiarity with the practice standard and reliance on habitual practices, with limited prioritization of patient needs.

Pharmacists adhered to some key elements of the practice standard when managing shortages, but gaps in patient-centered communication and consistent implementation remain. Strengthening awareness of the standard and improved communication are essential to ensure safe, equitable, and patient-focused care during shortages.