Medical Assignment: Impact Of Shortage Of Medicines On Patient’s Health

Question

Task: Context:
This medical assignment enables students to demonstrate their ability to evaluate and appraise evidence in healthcare research, an essential component of evidence-based practice and the exercise of clinical judgement in the delivery of quality healthcare.

Students will use a critical appraisal tool and other supporting references to appraise and interpret the sections and methodological quality of a research article including how well the evidence may be applied in evidence-based practice.

Instructions:
Students are required to conduct an evaluation of one journal article in an essay format. The article may be the selected one used in Assessment 2 Article Summary task. Alternatively, you may choose to select an article of your choice from the range of research articles supplied for the previous Assessment 2 assignment. This task requires using one of the critical appraisal tools supplied from a link below. Choose an appraisal tool that fits the chosen article to evaluation.

• CASP. (n.d.). CASP Checklists. Retrieved from https://casp-uk.net/casp-tools-checklists/
• Centre for Evidence-Based Medicine (CEBM). (2014). Critical Appraisal Tools. Retrieved from https://www.cebm.net/2014/06/critical-appraisal/

• Equator Network.(n.d.). Reporting guidelines for main study types. Retrievedfrom http://www.equator-network.org/
• Joanna Briggs Institute (n.d). Critical appraisal tools. Retrieved from https://jbi.global/critical-appraisal-tools

Answer

Introduction
The study analysed in the present context of medical assignment is performed by Atif, M., Sehar, A., Malik, I., Mushtaq, I., Ahmad, N., & Babar, Z. U. D. (2021). What impact do medicines shortages have on patients? A qualitative study exploring patients’ experience and views of healthcare professionals. BMC health services research, 21(1), 1-13. The topic is selected for research work to identify the impact of a shortage of medicines on the health of patients. The researcher is an M.Phil full-time student, she has done training in qualitative research sessions (COREQ checklist). It provokes the safety of the patient and can cause several health problems. To evaluate this study COREQ32 item checklist is used. The checklist has three sections and contains thirty-two items that make a clear and systematic understanding of the study. There is a correlation and overlapping between each question.

Body
The study was undertaken on patients of Pakistan to observe the impact of shortages of medicine on them. The study also focused on several other barriers that hampered the medicine shortage solutions. Qualitative research based on an interview approach was performed between July and September 2019. The participants in the study were recruited using a convenient and purposive sampling strategy. There was no defined sample size and was limited using saturation point criteria. All the data collected via interview were analyzed by thematic approach, transcribed verbatim, and audio recorded. In the study, about 35 participants were involved which includes 10 patients, 12 pharmacists, and 13 doctors. Five Themes and seven subthemes were used to portray the findings.

The aim of this study is to identify the impact of shortages of medicines on the health of patients (refers to the COREQ checklist). Medicine shortage is a complex global phenomenon that provokes patient safety and healthcare issues. There was a clear statement about the aim of the research. Shortage of medicine impactsa variety of medicines from several pharmacological groups from non-communicable to communicable diseases (Videau, et.al. 2019, Yang, et.al. 2016, Bocquet, et.al. 2017, American Society of Health-System Pharmacists, 2018). The goal of the research is to find solutions to reduce the shortage of medicine. The study is very important to impact the shortage of medicines on patients and know other barriers that hindered the solutions of a medicine shortage. The shortage of medicines has severe implications on a patient (Phuong, et.al. 2019, Tucker, et.al. 2020, US Food and Drug Administration, 2019).

Qualitative methodology was appropriate for the study (COREQ checklist). The study was conducted in Bahawalpur city of Pakistan (Atif, et.al. 2018). This approach was used to identify the views of doctors, pharmacists, and patients on the impact of medicine shortage on patients. Before the interview, the participants were asked to read the confidentiality statement and the purpose of the study. The reason behind the study was also mentioned to the participants (COREQ Checklist). To attain the objectives of the study and in-depth interview session was conducted. The study was conducted for education no biasness was observed or entertained throughout the study. The experiences and viewpoints of participants were effectively translated and recorded (Heiskanen, et.al., 2017).

Thematic analysis was done separately for the entire data collected from patients and all the health care professionals (COREQ Checklist, methodological orientation, and theory). AS Verbatim language translation was used to convert the transcribed interviews. The audio recorded were listened to carefully and then transcribed. To gain a deeper understanding of the data the transcripts were read several times and the audio recorded was listened to repeatedly. From each interview, sentences, phrases, and words related to the objective of the study were manually extracted (COREQ Checklist, theoretical framework). A list of abbreviations was made after consulting a research supervisor. Themes and subthemes were produced by bringing several types together. To enhance the trustworthiness of the data and ensure credibility of data cross-checking was done.

Convenient and purposive sampling was used to select the participants for the study (COREQ Checklist, sampling) (Atif, et.al., 2021). In the first stage, the health care professionals were purposefully approached via personal visits or phone calls during working hours. The healthcare professionals were brief about the study and were invited to participate in the study. On their demand, additional information was also provided to them. In the second stage, all who agreed to participate were face-to-face interviewed at their office or residence as per their convenience (COREQ Checklist, method of approach). The study was conducted among individuals with experience of more than three years for doctors and more than 1 year for pharmacists. This ensured the quality and reliability of the data. Patients visiting the drug retail outlets were also invited to participate in the study. It included patients who experienced a shortage of medicines, have or had any disease, and with or without prescription. The participants were interviewed as per their suitability (at the spot or any time convenient to them).

The total number of participants who were invited to participate in the study was forty-three. Of these, 13 were patients, 15 were pharmacists, and 15 were doctors. Out of these, only thirty-five participated in the study, seven people denied their participation due to busy schedules (COREQ checklist, non-participation). In all, 10 patients, 12 pharmacists, and 13 doctors participated in the research (COREQ Checklist, sample size). The number of female doctors was four while males were nine. There were six male and six female pharmacists. The patients had a secondary level of education. Of these four were females and six were males (COREQ Checklist, participant selection). The average interview duration with the patient, pharmacists, and doctors was 22mins, 28mins, 24mins, respectively. There were themes and subthemes to analyze the data.
The data was collected at the convenience of the doctors, pharmacists, and patients. It was collected in their residence, or offices, or restaurants (COREQ Checklist, setting of data collection). No other participants or individual was present while conducting the interview (COREQ Checklist, non-participants presence). The important characteristics of the sample were also mentioned. Both males and females participated in the study. The patient has a secondary-level education. While the doctors and pharmacists had an average experience of 7.9 and 3.8 years (COREQ Checklist, description of the sample). There were no repeated interviews. The audio recorded listened repeatedly. If any further clarity was required participants were called directly. No formal interview sessions were taken again to collect the data (COREQ Checklist, repeat interviews). Interviewers have audio recordings and transcripts for analyzing the data. On visual recordings were made during the interview session (COREQ checklist, audio/visual recording). Written transcripts were taken to attain a better understanding of the participant's responses (COREQ checklist, field notes). The average time taken to conduct the interview was 22mins, 28mins, 24mins with the patient, pharmacists, and doctors, respectively (COREQ Checklist, duration). All the data obtained were saturated (COREQ Checklist, data saturation). Saturation point criteria were applied to the data (Heiskanen, et.al. 2017). Three additional interviews were conducted to remove the uncertainty from the saturated data. Impressions and field notes were taken at the end of the interview. Any of the data collected from the participants like transcripts, field notes, and impressions were not returned to them. They were not even willing to read out their transcripts (COREQ checklist, transcripts returned).

The data was coded by all the authors and co-authors of the study except one. All of them generated the themes and subthemes of the study (COREQ Checklist, data analysis). There was a correlation between the data obtained from the data and the data presented in the paper. The objective of the study was completed. The five themes of the study were the impact of a shortage of medicines on patients, practices of patients in medicine shortage condition, pharmaceutical business and medical practices are influenced by medicine shortage, hindrances in the way ofproviding medicine shortage solutions, and suggestions to reduce the effect of shortage of medicines (COREQ checklist, major themes). The seven subthemes were impact on business, impact on doctors, financial burden, humanistic impact, clinical impact, healthcare professional advice during unavailability of medicine, and other approaches (COREQ Checklist, minor themes).

Conclusion
From the above study, it can be concluded that a shortage of medicine has a severe impact on the health of patients. It also impacts the pharmacist’s business and on the doctors. The study also highlighted the barriers that hindered the solutions to the shortage of medicines through themes and subthemes. Not only doctors, patients, and pharmacists must be involved in the study but also it must involve several other stakeholders and perform quantitative research to analyze the broader impact of a shortage of medicines on patients. To avoid treatment during the shortage of medicine, patients opt for several other risky practices. The shortage of medicines is usually not overcome due to switching between the brands. It is advised that proper patient consultation must be done, effective policies must be implemented, pharmacists must be actively involved in the healthcare delivery system, and the genric prescription must be promoted.

References
American Society of Health-System Pharmacists: Drug Shortages Statistics.In: University of Utah Drug Information Service; (2018). Available at: https://pharmacyservices.utah.edu/drug-information/index.php. Accessed on: 10 Aug 2021.
Atif, M., Azeem, M., Sarwar, M. R., Malik, I., Ahmad, W., Hassan, F., ... & Rana, M. (2018). Evaluation of prescription errors and prescribing indicators in the private practices in Bahawalpur, Pakistan. Journal of the Chinese Medical Association, 81(5), 444-449. https://doi.org/10.1016/j.jcma.2017.12.002.
Atif, M., Ihsan, B., Malik, I., Ahmad, N., Saleem, Z., & Sehar, A. (2021). Antibiotic stewardship program in Pakistan: a multicenter qualitative study exploring medical doctors’ knowledge, perception and practices. BMC infectious diseases, 21(1), 1-11.https://doi.org/10.1186/s12879-021-06043-5.
Bocquet, F., Degrassat-Théas, A., Peigné, J., & Paubel, P. (2017). The new regulatory tools of the 2016 Health Law to fight drug shortages in France. Medical assignmentHealth Policy, 121(5), 471-476. https://doi.org/10.1016/j.healthpol.2017.03.007.
Heiskanen, K., Ahonen, R., Kanerva, R., Karttunen, P., & Timonen, J. (2017). The reasons behind medicine shortages from the perspective of pharmaceutical companies and pharmaceutical wholesalers in Finland. PloS one, 12(6), e0179479.https://doi.org/10.1371/journal.pone.0179479.
Phuong, J. M., Penm, J., Chaar, B., Oldfield, L. D., & Moles, R. (2019). The impacts of medication shortages on patient outcomes: a scoping review. PloS one, 14(5), e0215837.https://doi.org/10.1371/journal.pone.0215837. Tucker, E. L., Cao, Y., Fox, E. R., & Sweet, B. V. (2020). The drug shortage era: a scoping review of the literature 2001–2019. Clinical Pharmacology & Therapeutics, 108(6), 1150-1155. https://doi.org/10.1002/cpt.1934
US Food and Drug Administration: Drug shortages: root causes and potential solutions. A Report by the Drug Shortages Task Force; 2019. https://www.fdagov/media/131130/download2019. Accessed 10 Aug 2021.
Videau, M., Lebel, D., & Bussières, J. F. (2019, May). Drug shortages in Canada: Data for 2016–2017 and perspectives on the problem. In Annales pharmaceutiques francaises (Vol. 77, No. 3, pp. 205-211). Elsevier Masson.https://doi.org/10.1016/j.pharma.2018.11.007
Yang, C., Wu, L., Cai, W., Zhu, W., Shen, Q., Li, Z., & Fang, Y. (2016). Current situation, determinants, and solutions to drug shortages in Shaanxi Province, China: a qualitative study. PloS one, 11(10), e0165183. https://doi.org/10.1371/journal.pone.0165183.

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