Martine Kruijtbosch

118 Chap t e r 3. 2 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 3 – Osteoporosis Mr. M., 76, is in the pharmacy with a repeat prescription for alendronic acid 70 mg. He has been using this medicine every week for three years for his osteoporosis. A year ago, he broke his arm due to a fall. Alendronic acid 70 mg will probably not be available again for a month. Mr M. indicates that he no longer has this medication left at home. 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 the patient may go to another pharmacy if I do not solve this problem 2. That I receive a complaint from the Community Pharmacists Disputes Committee 3. That weekly administration is preferable to daily administration for ease of use 4. That I do not deviate from the Fracture Prevention Guideline of The Dutch College of General Practitioners 5. Whether not using alendronic acid for a few weeks is a problem 6. Whether the patient has read about the medicine on the Internet 7. That I have a valid prescription if I were to substitute 8. Whether the Health and Youth Care Inspectorate consents to the import of alendronic acid 70 mg 9. That when I receive a prescription, I always want to deliver the medicine because I am paid per prescription- line 10. Whether there is evidence that alternative bisphosphonates are equally effective 11. That the extra time I spend searching for an alternative will not be reimbursed 12. That the patient worries that he will break a bone again 13. Whether the health insurer will reimburse the/an alternative