A multinational MDForLives survey of pharmacists shows how supply disruption changes sourcing, therapeutic substitution, medication-safety risk, clinical prioritization, and the day-to-day work required to keep treatment moving.
Audience: Pharmacists
Countries: 6
Completion Rate: 70.5%
SGID: 9016538
-Hero findings
– Quick Read — Key Findings
For pharmacists, shortage management is not successful simply because stock is located. It is successful when patients can continue clinically appropriate treatment without avoidable harm.
Treatment continuity is the outcome most chosen as the sign of effective shortage management at 80.7% (up to two allowed), ahead of fewer medication errors (43.8%), shorter stockout duration (42.5%) and lower acquisition cost (8.6%). That ordering puts patient care and safety ahead of the commercial cost of stock: a pharmacy may pay more or change sourcing yet still count the response a success if treatment stays clinically appropriate and safe.
When supply cannot cover every need, pharmacists move from inventory management into explicit clinical prioritization.
Clinical urgency most determines allocation at 43.0%, ahead of available inventory (27.0%), treatment continuity (19.3%) and patient-specific risk (10.7%). So allocation is not first-come, first-served: the pharmacy matches limited supply to the consequences of delay, the availability of substitutes, patient stability and the therapeutic importance of uninterrupted treatment.
Substitution solves one risk only if the pharmacy also manages the changes that come with the replacement product.
Unfamiliar substitute products are the biggest driver of error risk at 46.9%, ahead of concentration changes (26.8%), increased workload (17.2%) and new dosing requirements (9.2%), while the substitution choice itself is anchored in therapeutic equivalence (53.2%). The clinical question is not only whether an alternative exists, but whether it can be introduced safely across prescribing, dispensing, preparation, administration and counseling.
The first response is nearly evenly split between finding more of the same medicine and finding a clinically acceptable alternative.
Contacting alternative suppliers (39.2%) and identifying therapeutic alternatives (38.8%) are near-tied as the first response, with prioritizing limited inventory (16.3%) and restricting dispensing (5.8%) behind. That near tie is telling: shortages cross the boundary between procurement and clinical pharmacy at once, so while buyers chase supply the care team may also need an alternative product, strength, form or plan ready.
Pharmacists can redesign local workflows, but they cannot fully control whether upstream supply is dependable.
Unreliable supplier availability most limits shortage management at 46.4%, ahead of limited inventory (32.6%), prescriber-coordination delays (15.5%) and pharmacy staffing (5.6%). That outward-facing constraint is why the future-resilience question points outward too, with 35.6% choosing multi-source procurement networks as the development most likely to strengthen supply resilience.
A shortage does not create the same level of harm for every medicine or every patient group.
Critical-care patients need the greatest shortage-related oversight at 30.3%, with narrow-therapeutic-index users (27.4%), oncology (21.8%) and pediatric patients (20.5%) close behind, while on the product side injectables (33.1%) and chronic-disease therapies (32.7%) lead the risk categories. The same stockout can have very different consequences depending on dose precision, alternatives, route, urgency and the patient’s stability.
The bigger story is not that pharmacists are searching for stock, but that every shortage can trigger a chain of clinical decisions: who receives limited supply, whether a substitute is therapeutically equivalent, what new error risks the replacement introduces, which patients need closer oversight, and how quickly prescribers and frontline teams can adopt the change.
The survey points to a profession protecting continuity while holding incomplete control over the upstream problem: clinical urgency governs allocation, therapeutic equivalence governs substitution, unfamiliar products create new error risk, and supplier unreliability remains the dominant operational limit. That is why pharmacists look to multi-source procurement, better shortage intelligence and coordinated supply systems.
What remains unresolved is visibility: the safest substitution plan still becomes harder when teams do not know how long a shortage will last, what stock arrives next, or whether another supplier can reliably fill the gap. Better shortage management therefore needs both disciplined clinical governance inside the health system and stronger supply transparency outside it.
You have read the summary
Dive deeper into the research, or take part in future studies that turn real healthcare perspectives into meaningful insights.
Concise answers to common questions pharmacists, care teams, and healthcare leaders ask when supply disruption changes medication use.
Direct answers to the questions healthcare professionals are most likely to ask about these findings.
