Martine Kruijtbosch

117 Mo ra l r eason i ng pe r spec t i ves i n s i t ua t i on s o f d rug s ho r t ages TABLE 6: Continued Question 3. Choose the four considerations most important for you to deal with this scenario and rank these four considerations as follows: position 1 (most important) to position 4 is (fourth-most important). Drug shortage scenario 2 – Parkinson’s The wife of 78-year-old Mr G. is standing at the counter with a prescription for her husband. Her husband has Parkinson’s and does not go outside without her. Six-times daily levodopa/carbidopa "125" and 1-time daily ropinirole 8 mg have been prescribed by a neurologist. Mr G.'s wife states that her husband is well-adjusted to levodopa/carbidopa. The levodopa/carbidopa ‘125’ combination has not been available for some time and is expected again in 3 months. 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 the handling of this drug shortage scenario? 1. That every patient has equal access to levodopa/carbidopa 125 mg 2. That I adhere to the contract with the health insurer 3. That this patient is a regular customer who takes many medications 4. That in the case of Parkinson's medication I never deviate from the KNMP Drug Substitution Guideline 5. That Parkinson’s can worsen when the patient receives alternative treatment 6. That the treating neurologist is a good friend of mine 7. That I can trust the quality of imported levodopa/carbidopa 125 mg tablets 8. That the patient may go to another pharmacy if I do not solve this problem 9. Whether I can do something for this patient with my pharmaceutical expertise 10. That I adhere to the advice/prescription of the treating prescriber 11. Whether the Health and Youth Care Inspectorate consents to the import of levodopa/carbidopa 125 mg tablets 12. That the neurologist recognises my pharmaceutical expertise with Parkinson’s 13. That the extra time I spend searching for an alternative will not be reimbursed