Drug shortages in the United States have prompted 87% of clinicians to make changes in their practice, according to data from a new survey of approximately 900 individuals.

Persistent drug shortages arise from multiple factors, including supply chain disruptions, a limited number of manufacturers, regulatory burdens, small profit margins, as well as external factors such as natural disasters and unforeseen surges in demand for certain drugs. However, data on the effect of drug shortages on clinical practice are limited, wrote Jennie B. Jarrett, PharmD, director of science and drug policy at the American Medical Association (AMA) in Chicago, and colleagues. 

In a study published in JAMA Network Open, the researchers investigated the effect of drug shortages on primary care clinicians and their patients via a cross-sectional, web-based survey conducted from July 2024 to August 2024. The final analysis included 902 primary care clinicians from a combination of family medicine practices (42%), outpatient-only practices (75%), urban settings (78%), and private practices (71%). Of these, 795 reported a perceived drug shortage in the past 6 months.

Respondents reported that drug shortages affected 20% of their patients on average. Overall, endocrinology drugs had the highest rate of severe outcomes associated with shortages (54%), followed by stimulants (52%), drugs for infectious diseases (26%), pulmonology (17%), and pain management (14%). Pediatricians reported the greatest impact from shortages associated with infectious disease, pulmonology, and stimulant medications.

Among the 87% of clinicians who reported changes in quality of care based on shortages, 92% said they changed the medication of choice, while 63% said they postponed prescribing. Pediatricians were less likely to postpone prescribing than family medicine physicians or internal medicine physicians. 

The top considerations in drug shortage management were drug efficacy (89%), adverse effects (81%), out-of-pocket costs (78%), prior authorization (73%), and route of administration (58%). The most commonly reported outcome of a drug shortage was discontinuation of the medication (98%). However, approximately half (49%) reported disease progression, 13% reported major adverse events, and 2% reported patient deaths.

In addition, 44% of respondents reported concerns that no substitute drug might be available, 241 (30%) described requiring a combination of substitute medications to manage a shortage, and 85 (11%) were concerned about dispensing errors from changing treatment.

Notably, the findings highlight the lack of communication on drug shortages, the researchers wrote in their discussion. Patient communication and community pharmacists were the most common sources of drug shortage notification (73% and 70%, respectively), and resolution of a shortage (61% and 57%, respectively).

The findings were limited by several factors, including the overestimation of perceived drug shortages because of oversampling of physicians who were affected, possible lack of disclosure of outcomes by patients and physicians, and the inability to prove that responses were caused by genuine drug shortages, the researchers wrote.

Although some of the outcomes of shortages, such as discontinuing unavailable medications, were not unexpected, the severity of outcomes reported by physicians, including major adverse events and death, was surprising, Jarrett told Medscape Medical News. The survey findings also highlight the administrative burden of drug shortages on primary care clinicians, she added. 

The survey’s main takeaway is that physician-led, team-based care is important for managing challenges posed by drug shortages and improving access to medications, Jarrett said. “Communication and care coordination of physicians and pharmacists are integral to individualized, patient-centered care,” she added.

However, the results suggest the need for better communication and strategies to manage the reported administrative burdens accompanying drug shortages. These burdens included prior authorization, frustration, and burnout, and respondents reported a median of 0.5 full-time equivalents of new staff time to manage the added workload associated with drug shortage, she said.

In addition, given the reported lack of physician awareness of drug shortages, physician perceptions of what is and is not available at any given time may differ from the actual supply, Jarrett said. “Similarly, the gap in awareness of when a drug has its shortage resolved compared to when it is ongoing may cause physicians to alter their practice longer than necessary,” she said.

Confusion in the Clinic 

Medical breakthroughs in diagnosing, treating, and preventing diseases do not have real-world meaning unless they are getting to the patients, said Tim Joos, MD, an internist and pediatrician at Neighborcare Health in Seattle. “This is never more obvious than when a therapy that a patient has been benefiting from is interrupted by problems with short supply and delivery logistics,” said Joos, who was not involved in the study.

Analysis of the causes and effects of these interruptions is important to improve healthcare and overall public health, Joos told Medscape Medical News. “The study highlights a lot of what I see in my own practice,” he said. Direct communication from pharmacies to prescribers about a drug shortage is rare, he said. “The patients themselves are often confused about why they didn’t get the medicine, and I often don’t hear about it until months later when they come in for follow-up and don’t have the medicine,” he said. Even then, the reason for the shortage, whether a supply issue or formulary issue, is often unclear, he added.

“Improved communication about shortages by pharmacies, pharmaceutical and insurance companies, and perhaps health departments would help mitigate the detrimental effects of drug shortages,” Joos said.

The study received no outside funding. Jarrett disclosed grants from the CDC unrelated to the current study. Jarrett’s opinions are her own and do not reflect any AMA policy. Joos disclosed no financial conflicts of interest.