Martine Kruijtbosch

126 Chap t e r 3. 3 ABSTRACT Background: Although the nature, extent and impact of drug shortages on patients have been researched extensively, the impact on pharmacists’ moral reasoning and pharmacists’ dominant moral reasoning perspective (MRP) has not. Objective: To identify determinants of community pharmacists’ dominant MRPs in situations of drug shortages. Setting: Dutch community pharmacy Methods: An electronic survey about three drug shortage scenarios with a varying impact on patient outcomes (a Contraceptive, a Parkinson’s and an Osteoporosis scenario) was distributed among 267 community pharmacists. Pharmacists provided several characteristics (gender, age, type of pharmacy and job profile), rated the likelihood of nine intended handling options and rated and ranked 13 considerations that may have played a role in the situations. The considerations represented three MRPs: a business orientation, rules and regulations and professional ethics MRP. Main outcome measure: Associations between determinants and dominant MRPs. Results: When confronted with the Osteoporosis, Contraceptive and Parkinson’s drug shortage scenarios, 199 (74.5%), 164 (61.4%) and 212 (79.4%) pharmacists had dominant PE- MRPs, respectively. Managing pharmacists (adjusted odds ratio (OR), 0.51; 95% confidence interval (CI), 0.32-0.83) and the Contraceptive scenario (OR, 0.42; 95% CI, 0.28-0.62) were significantly associated with a lower likelihood of a dominant PE-MRP. Only in the Parkinson’s drug shortage scenario, pharmacists with dominant PE-MRPs were significantly more likely to import the medicine (OR, 3.04; 95% CI, 1.62-5.72). Conclusion: Community pharmacists’ dominant PE-MRPs are especially influenced by the potential impact of a drug shortage scenario on patient outcomes rather than by pharmacists’ characteristics.