Moral reasoning perspectives of community pharmacists in situations of drug shortages

M Kruijtbosch; A Floor-Schreudering; E van Leeuwen; W Göttgens-Jansen; M L Bouvy

doi:10.1016/j.sapharm.2020.11.012

Moral reasoning perspectives of community pharmacists in situations of drug shortages

M Kruijtbosch, A Floor-Schreudering, E van Leeuwen, W Göttgens-Jansen, M L Bouvy

Radboud University Medical Center, Radboud Institute for Health Sciences (RIHS), P.O. Box 9101, 148 RIHS, 6500 HB, Nijmegen, the Netherlands. Electronic address: [email protected].

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Drug shortages affect health systems worldwide. Research in community pharmacy has focused on the nature, extent and impact of these shortages on patients and pharmacists. However, pharmacists' moral reasoning in situations of drug shortages has not been addressed.

OBJECTIVE: To explore the moral reasoning perspectives of Dutch community pharmacists in situations of drug shortages.

METHOD: An electronic survey was developed around three drug shortage scenarios with a varying impact on patient outcomes: a Contraceptive, a Parkinson's and an Osteoporosis scenario. Pharmacists rated the likelihood of nine handling options and rated and ranked 13 considerations that may have played a role therein. The considerations represented three moral reasoning perspectives (MRPs): a business orientation (BO), a rules and regulations (RR), and a professional ethics (PE) MRP. Principle component analysis (PCA) was used to investigate construct validity of the MRPs. MRP rating and MRP ranking scores measured the relative importance of the different MRPs of pharmacists in the three shortages.

RESULTS: Results from 267 Pharmacists were obtained. They reported mostly similar handling in the three shortages, except for the likelihood to make agreements with prescribers or other pharmacists and regarding the decision to import a product. The PCA analysis confirmed the three MRPs that accounted for 29% of variance in the data. Both the MRP rating and especially the MRP ranking scores indicated that PE-MRP considerations were most influential on pharmacists' intended handling of the shortages. In the Contraceptive and the Osteoporosis scenarios, the relative importance of a BO-MRP was higher than in the Parkinson's scenario.

CONCLUSION: Pharmacists predominantly reason with a PE-MRP when handling drug shortages. However, this perspective can be compromised when the drug shortage is perceived to have a lower impact on patient outcomes and when alternative drugs or therapy are expensive.

Original language	English
Pages (from-to)	2424-2431
Number of pages	8
Journal	Research in Social and Administrative Pharmacy
Volume	18
Issue number	3
Early online date	21 Nov 2020
DOIs	https://doi.org/10.1016/j.sapharm.2020.11.012
Publication status	Published - Mar 2022

Bibliographical note

Funding Information:
We express our gratitude to all the pharmacists who participated in this study and specifically the pharmacists who were members of our expert panel and advised us during development of the surveyl: Peter van Hartingsveldt, Dorien Hazelzet, Ad Hoevenaars, Annemieke Horikx and Guusta Huizer.

Publisher Copyright:
© 2020 The Authors

Keywords

Community pharmacists
Drug shortages
Moral reasoning
Netherlands
Pharmacy ethics

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1-s2.0-S1551741120311979-mainFinal published version, 506 KBLicence: CC BY

Cite this

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title = "Moral reasoning perspectives of community pharmacists in situations of drug shortages",

abstract = "BACKGROUND: Drug shortages affect health systems worldwide. Research in community pharmacy has focused on the nature, extent and impact of these shortages on patients and pharmacists. However, pharmacists' moral reasoning in situations of drug shortages has not been addressed.OBJECTIVE: To explore the moral reasoning perspectives of Dutch community pharmacists in situations of drug shortages.METHOD: An electronic survey was developed around three drug shortage scenarios with a varying impact on patient outcomes: a Contraceptive, a Parkinson's and an Osteoporosis scenario. Pharmacists rated the likelihood of nine handling options and rated and ranked 13 considerations that may have played a role therein. The considerations represented three moral reasoning perspectives (MRPs): a business orientation (BO), a rules and regulations (RR), and a professional ethics (PE) MRP. Principle component analysis (PCA) was used to investigate construct validity of the MRPs. MRP rating and MRP ranking scores measured the relative importance of the different MRPs of pharmacists in the three shortages.RESULTS: Results from 267 Pharmacists were obtained. They reported mostly similar handling in the three shortages, except for the likelihood to make agreements with prescribers or other pharmacists and regarding the decision to import a product. The PCA analysis confirmed the three MRPs that accounted for 29% of variance in the data. Both the MRP rating and especially the MRP ranking scores indicated that PE-MRP considerations were most influential on pharmacists' intended handling of the shortages. In the Contraceptive and the Osteoporosis scenarios, the relative importance of a BO-MRP was higher than in the Parkinson's scenario.CONCLUSION: Pharmacists predominantly reason with a PE-MRP when handling drug shortages. However, this perspective can be compromised when the drug shortage is perceived to have a lower impact on patient outcomes and when alternative drugs or therapy are expensive.",

keywords = "Community pharmacists, Drug shortages, Moral reasoning, Netherlands, Pharmacy ethics",

author = "M Kruijtbosch and A Floor-Schreudering and {van Leeuwen}, E and W G{\"o}ttgens-Jansen and Bouvy, {M L}",

note = "Funding Information: We express our gratitude to all the pharmacists who participated in this study and specifically the pharmacists who were members of our expert panel and advised us during development of the surveyl: Peter van Hartingsveldt, Dorien Hazelzet, Ad Hoevenaars, Annemieke Horikx and Guusta Huizer. Publisher Copyright: {\textcopyright} 2020 The Authors",

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AU - Kruijtbosch, M

AU - Floor-Schreudering, A

AU - van Leeuwen, E

AU - Göttgens-Jansen, W

AU - Bouvy, M L

N1 - Funding Information: We express our gratitude to all the pharmacists who participated in this study and specifically the pharmacists who were members of our expert panel and advised us during development of the surveyl: Peter van Hartingsveldt, Dorien Hazelzet, Ad Hoevenaars, Annemieke Horikx and Guusta Huizer. Publisher Copyright: © 2020 The Authors

PY - 2022/3

Y1 - 2022/3

N2 - BACKGROUND: Drug shortages affect health systems worldwide. Research in community pharmacy has focused on the nature, extent and impact of these shortages on patients and pharmacists. However, pharmacists' moral reasoning in situations of drug shortages has not been addressed.OBJECTIVE: To explore the moral reasoning perspectives of Dutch community pharmacists in situations of drug shortages.METHOD: An electronic survey was developed around three drug shortage scenarios with a varying impact on patient outcomes: a Contraceptive, a Parkinson's and an Osteoporosis scenario. Pharmacists rated the likelihood of nine handling options and rated and ranked 13 considerations that may have played a role therein. The considerations represented three moral reasoning perspectives (MRPs): a business orientation (BO), a rules and regulations (RR), and a professional ethics (PE) MRP. Principle component analysis (PCA) was used to investigate construct validity of the MRPs. MRP rating and MRP ranking scores measured the relative importance of the different MRPs of pharmacists in the three shortages.RESULTS: Results from 267 Pharmacists were obtained. They reported mostly similar handling in the three shortages, except for the likelihood to make agreements with prescribers or other pharmacists and regarding the decision to import a product. The PCA analysis confirmed the three MRPs that accounted for 29% of variance in the data. Both the MRP rating and especially the MRP ranking scores indicated that PE-MRP considerations were most influential on pharmacists' intended handling of the shortages. In the Contraceptive and the Osteoporosis scenarios, the relative importance of a BO-MRP was higher than in the Parkinson's scenario.CONCLUSION: Pharmacists predominantly reason with a PE-MRP when handling drug shortages. However, this perspective can be compromised when the drug shortage is perceived to have a lower impact on patient outcomes and when alternative drugs or therapy are expensive.

AB - BACKGROUND: Drug shortages affect health systems worldwide. Research in community pharmacy has focused on the nature, extent and impact of these shortages on patients and pharmacists. However, pharmacists' moral reasoning in situations of drug shortages has not been addressed.OBJECTIVE: To explore the moral reasoning perspectives of Dutch community pharmacists in situations of drug shortages.METHOD: An electronic survey was developed around three drug shortage scenarios with a varying impact on patient outcomes: a Contraceptive, a Parkinson's and an Osteoporosis scenario. Pharmacists rated the likelihood of nine handling options and rated and ranked 13 considerations that may have played a role therein. The considerations represented three moral reasoning perspectives (MRPs): a business orientation (BO), a rules and regulations (RR), and a professional ethics (PE) MRP. Principle component analysis (PCA) was used to investigate construct validity of the MRPs. MRP rating and MRP ranking scores measured the relative importance of the different MRPs of pharmacists in the three shortages.RESULTS: Results from 267 Pharmacists were obtained. They reported mostly similar handling in the three shortages, except for the likelihood to make agreements with prescribers or other pharmacists and regarding the decision to import a product. The PCA analysis confirmed the three MRPs that accounted for 29% of variance in the data. Both the MRP rating and especially the MRP ranking scores indicated that PE-MRP considerations were most influential on pharmacists' intended handling of the shortages. In the Contraceptive and the Osteoporosis scenarios, the relative importance of a BO-MRP was higher than in the Parkinson's scenario.CONCLUSION: Pharmacists predominantly reason with a PE-MRP when handling drug shortages. However, this perspective can be compromised when the drug shortage is perceived to have a lower impact on patient outcomes and when alternative drugs or therapy are expensive.

KW - Community pharmacists

KW - Drug shortages

KW - Moral reasoning

KW - Netherlands

KW - Pharmacy ethics

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DO - 10.1016/j.sapharm.2020.11.012

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SN - 1551-7411

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JO - Research in Social and Administrative Pharmacy

JF - Research in Social and Administrative Pharmacy

IS - 3

ER -

Moral reasoning perspectives of community pharmacists in situations of drug shortages

Abstract

Bibliographical note

Keywords

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