Martine Kruijtbosch

116 Chap t e r 3. 2 APPENDIX TABLE 6: Survey of moral reasoning of community pharmacists in situations of drug shortages Drug shortage scenario 1 – Contraceptive Mrs. B., 22, is at the counter with a repeat prescription for ethinylestradiol/levonorgestrel 0.03/0.150 mg tablets (oral). Mrs. B. says that without this contraceptive pill she will be bedridden for at least two days during her period due to severe menstrual pain. Ethinylestradiol/levonorgestrel 0.03/0.15 mg tablets will only be available again in 6 months, and the pharmacy has nothing in stock. This contraceptive is not available anywhere in the Netherlands. Question 1. How likely would you be to handle this situation the following way? Rating options: very likely, likely, unlikely, very unlikely 1. I explain to the patient that I cannot dispense the medicine due to its shortage 2. I refer the patient to the prescriber for possible alternative (pharmaceutical) treatments 3. I propose a possible alternative pharmaceutical treatment to the prescriber 4. I discuss possible alternative (pharmaceutical) treatments with the patient 5. I import the medicine of which there is a shortage 6. I have made agreements in advance with the prescribers in my area related to alternatives for this drug shortage 7. I have made agreements in advance with pharmacists in my area related to alternatives for this drug shortage 8. I advise the patient to check whether another pharmacy has this medicine in stock 9. I check other pharmacies in my area on behalf of the patient to see if they still have this medicine in stock Question 2. To what extent do the following considerations play a role in handling this drug shortage scenario? Rating options: very strong, strong, weakly, very weakly, no role 1. That I adhere to the advice regarding this shortage on the Farmanco website 2. That the patient may suffer from menstrual pain without contraception 3. That every patient has equal access to this oral contraceptive 4. Whether the Health and Youth Care Inspectorate consents to the import of this oral contraceptive 5. Whether the patient is willing to pay the extra costs of an imported oral contraceptive 6. The number of patients for whom I may have to import a foreign oral contraceptive 7. That I do not deviate from professional guidelines 8. Whether the patient's neighbour comes to the pharmacy where I work 9. Whether I run the risk of a complaint from a disciplinary court for healthcare 10. Whether I can answer the care question of this patient with my pharmaceutical expertise 11. Whether pharmacists in the vicinity of my pharmacy import this oral contraceptive 12. The expected duration for which the patient cannot use ethinylestradiol/levonorgestrel 0.03/0.150 mg tablets 13. The relative price of imported ethinylestradiol/levonorgestrel