Martine Kruijtbosch

98 Chap t e r 3. 2 Drug shortage scenario construction The investigators first selected nine drug shortages which met the following criteria: the shortage affected all Dutch pharmacies in 2018-2019 and the shortage had a duration of at least 3 months. Subsequently an expert panel consisting of seven practicing community pharmacists selected three shortages that were expected to have a varying impact on patients outcomes: a contraceptive shortage (Contraceptive scenario), a levodopa shortage (Parkinson’s scenario) and an alendronic acid shortage (Osteoporosis scenario). See Table 2 for the perceived relevance of these three shortages. TABLE 2: The three drug shortages used in the study Drug shortage scenario Duration Average number of users per pharmacy a Perceived relevance of the shortage (impact on patient outcomes) 1 – Contraceptive (Ethinylestradiol/ Levonorgestrel 0.03/0.15 mg [oral] tablet) May 2018– November 2019 500 b Medium; although alternative treatments were available, women had to switch to oral contraceptives with a different composition of active ingredients 2 – Parkinson’s medicine (Levodopa/Carbidopa 125 mg tablet) January 2018–Present (Irregular supply persists) 19 c High; switching to alternative treatment required a pharmacotherapeutic substitution with a potentially reduced ability to control Parkinson’s symptoms 3 – Osteoporosis medicine (Alendronic acid 70 mg tablet) February 2019–Present (Irregular supply persists) 61 c Low; alternatives were available but were less practical (e.g. daily alendronic acid, 10 mg instead of 70 mg once a week) and temporary discontinuation of bisphosphonates did not jeopardize patients’ health a 1.996 community pharmacies in theNetherlands per January 1, 2018, published by the Foundation for Pharmaceutical Statistics in The Hague in its Annual Report ‘‘SFK Data en feiten 2019’’. b Stichting Farmaceutische Kengetallen, 2019 45 c National Health Care Institute. The drug information system. https://GIPdatabank.nl . Survey development An electronic survey was developed by the research team (MK, AF and MB); this survey was based on cognitive moral development literature, 28,29,32 (inter)national pharmacy practice literature, 16,39,46-49 and the context of Dutch pharmacy practices (see the survey in Appendix, Table 6). For each of the three drug shortage scenarios, the respondents had to use a four point scale (very likely, likely, unlikely, very unlikely) to rate the likelihood that they would use each of nine options of intended action to address the shortage. A four-point scale for rating the likelihood of the intended action options was chosen to force respondents to choose