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This study aims to investigate the supply chain gaps during the COVID-19 pandemic in Tanzania amid the pandemic era.

This study adopted a mixed approach, using both structured questionnaires and individual interviews to gather raw data (quantitative and qualitative data). To assess quantitative data for statistical (descriptive and inferential) analysis, this study used a sample of 57 wholesale and retail pharmacies and 10 hospital pharmacies, which were randomly selected. The thematic analysis was applied to the gathered qualitative data to authenticate the quantitative findings and conclusions which were the outcome of the descriptive and inferential analysis (binary logistics regression) analysed by the SPSS.

The results revealed the presence of various supply chain gaps in terms of target gaps, time gaps and coverage gaps. This study highlighted the disruption on demand and uncertainty in business environment as ways that the COVID-19 pandemic contributed to the gaps and revealed the negative effects of the supply chain gaps on the effectiveness of medical supplies in Tanzania.

The results revealed the presence of various supply chain gaps (in terms of target gaps, time gaps and coverage gaps), underlined the disruption in demand and uncertainty in the business environment as ways that the COVID-19 pandemic contributed to the gaps and revealed the negative effects of the supply chain gaps on the effectiveness of medical supplies in Tanzania.

Data generated and used in this study is from participants from one country only (Tanzania), despite the supply chain gaps being common to many developing countries in general.

This study provides a novel framework in medical supply chain literature by identifying numerous disruptions in the medical supply chain which emerged during the COVID-19 emergence and serves as a basis for future studies on how to counter the gaps and rebuild a resilient and sustainable medical supply chain in developing countries.

Pharmaceutical supply chains (PSCs) need a well-operating and faultless logistics system to successfully store and distribute their medicines. Hospitals, health institutes, and pharmacies must maintain extra stock to respond requirements of the patients. Nevertheless, there is an inverse correlation between the level of medicine stock and logistics service level. The high stock level held by health institutions indicates that we have not sufficiently excellent logistics systems presently. As such, selecting appropriate logistics service providers (drug distributors) is crucial and strategic for PSCs. However, this is difficult for decision-makers, as highly complex situations and conflicting criteria influence such evaluation processes. So, a robust, applicable, and strong methodological frame is required to solve these decision-making problems.

To achieve this challenging issue, the authors develop and apply an integrated entropy-WASPAS methodology with Fermatean fuzzy sets for the first time in the literature. The evaluation process takes place in two stages, as in traditional multi-criteria problems. In the first stage, the importance levels of the criteria are determined by the FF-entropy method. Afterwards, the FF-WASPAS approach ranks the alternatives.

The feasibility of the proposed model is also supported by a case study where six companies are evaluated comprehensively regarding ten criteria. Herewith, total warehouse capacity, number of refrigerated vehicles, and personnel are the top three criteria that significantly influence the evaluation of pharmaceutical distribution and warehousing companies. Further, a comprehensive sensitivity analysis proves the robustness and effectiveness of the proposed approach.

The proposed multi-attribute decision model quantitatively aids managers in selecting logistics service providers considering imprecisions in the multi-criteria decision-making process.

A new model has been developed to present a sound mathematical model for selecting logistics service providers consisting of Fermatean fuzzy entropy and WASPAS methods. The paper's main contribution is presenting a comprehensive and more robust model for the ex ante evaluation and ranking of providers.

This study aims to enhance storage and distribution operations at a pharmaceutical supply center (PSC) in primary health care (PH) using lean health care (LH) tools. Supply centers for health products, medications and supplies have unique characteristics compared to centers for other goods due to complex processes, specific services, diverse stakeholders and multiple interactions. The authors adapt LH tools to address these complexities and meet industry-specific needs.

The investigation unit is a PSC in a large southern Brazilian city, and the processes analyzed are the storage and distribution of medications. The authors performed action research from June 2019 to February 2020. Data collection and problem diagnosis involved the development of a value stream mapping.

The authors adapted the overall equipment effectiveness calculation, efficiency analysis, and loss classification for PSC operations. Eighteen core issues were found: waiting, movement, transport, stock, inadequate processing, defects and human potential losses. The authors proposed waste reduction tools and practices. Inadequate storage conditions may compromise medicine quality, efficacy and safety. This can result from lacking physical structures or noncompliance with procedures. Next, the authors recommend simulating scenarios for validation before implementation.

The study explored ways to enhance layout and medicine distribution at the PSC, focusing on reducing loss and cost impact.

Originality lies in LH application in a PSC of PH, often applied in secondary or tertiary health levels like hospitals. The novelty necessitated adaptations of tools for future PSC applications.

The study aims to estimate the prevalence of workplace bullying, personal and work-related impacts, reporting practices for bullying, and the reasons for not reporting bullying incidents in the New Zealand pharmacy sector.

An online survey was conducted among registered pharmacists and pharmacist interns in New Zealand from June to August 2020. The questionnaire comprises both close-ended and semi-structured free-text questions. Goldberg’s 12-item General Health Questionnaire (GHQ-12) assessed the respondents’ general psychological health status, and a 22-item Negative Acts Questionnaire-Revised (NAQ-R) was used to estimate bullying prevalence together with the self-rated/self-labeled questions. The qualitative information obtained from the free-text responses was used to support and elaborate on the quantitative results.

The self-labeled prevalence of workplace bullying was 36.9%, with almost 10% reporting it occurring almost daily to several times per week. The 54.7% prevalence based on the NAQ-R assessment compares well with the prevalence of witnessing the incidents (58.5%). Psychological distress symptoms were experienced by 37.1% in pre-COVID and 45.3% during COVID-year 1. Supervisors or direct managers were the commonest perpetrators (32.7%). Only 28.8% of those who experienced bullying had reported the incidents formally.

This study is cross-sectional, and the relationships indicated are bi-directional. The consistency of the results is reassuring, however inferring causality of effect is challenging. Future studies and analyses should focus on this. This study suggests that in the pharmacy environment bullying from the top is reasonably prevalent, is not commonly reported and requires the design and implementation of prevention and management strategies that take into account and mitigate these bullying factors. Professional pharmacy leadership organizations, National Health Authority and Pharmacy regulators could play a significant role in awareness and training to reduce bullying with the development and promotion of strategies to curb it and improve reporting.

This is the first paper to describe the prevalence and impact of workplace bullying, and the practices of reporting bullying incidents in the New Zealand pharmacy sector. Based on empirical evidence, pharmacists represent a small share of total healthcare workforce, yet the overall prevalence of bullying is consistent with professions with much larger numbers such as medicine and nursing.

This paper aims to investigate the relationship between entrepreneurial motivation and pharmapreneurial intention among pharmacists in Jordan.The authors also assessed the moderating effect of gender and the COVID-19 pandemic on the relationship between these two variables.

This study is a quantitative study targeting pharmacists and using a nonprobability sample. A structured questionnaire was distributed through official channels to the entire population of registered pharmacists in Jordan. SmartPLS 3 was used for carrying an advanced structural equation model analysis, and SPSS 26 for the descriptive statistics.

The three entrepreneurial motivation variables (behavioral control [BC], risk tolerance and desirability of self-employment) affected pharmapreneurial intention, with BC contributing more to pharmapreneurial intention among pharmacists in Jordan than the other variables examined. On the other hand, gender and COVID-19 did not moderate this relationship.

The authors find that entrepreneurial motivation affects pharmapreneurial intention. Consequently, the authors provide insights to policymakers and educators regarding dovetailing the recent financial literacy programs implemented in Jordanian schools with medical education in Jordan to better motivate the formation of pharmapreneurial intention.

Policymakers and educators should be dovetailing the recent financial literacy programs implemented in Jordanian schools with medical education in Jordan to better motivate the formation of pharmapreneurial intention.

To the best of the authors’ knowledge, this is the first study to examine pharmapreneurship in Jordan.

Adoption of Clinical Decision Support Systems (CDSS) is a crucial step towards the digital transition of the healthcare sector. This review aims to determine and synthesise the influential factors in CDSS adoption in inpatient healthcare settings in order to grasp an understanding of the phenomenon and identify future research gaps.

A systematic literature search of five databases (Medline, EMBASE, PsycINFO, Web of Science and Scopus) was conducted between January 2010 and June 2023. The search strategy was a combination of the following keywords and their synonyms: clinical decision support, hospital or secondary care and influential factors. The quality of studies was evaluated against a 40-point rating scale.

Thirteen papers were systematically reviewed and synthesised and deductively classified into three main constructs of the Technology–Organisation–Environment theory. Scarcity of papers investigating CDSS adoption and its challenges, especially in developing countries, was evident.

This study offers a summative account of challenges in the CDSS procurement process. Strategies to help adopters proactively address the challenges are: (1) Hospital leaders need a clear digital strategy aligned with stakeholders' consensus; (2) Developing modular IT solutions and conducting situational analysis to achieve IT goals; and (3) Government policies, accreditation standards and procurement guidelines play a crucial role in navigating the complex CDSS market.

To the best of the authors’ knowledge, this is the first review to address the adoption and procurement of CDSS. Previous literature only addressed challenges and facilitators within the implementation and post-implementation stages. This study focuses on the firm-level adoption phase of CDSS technology with a theory refining lens.

Increased outsourcing and importation of drugs from different parts of the world to the Latin America and the Caribbean (LAC) region result in the proliferation of substandard and fake medicines, posing a threat to public health. The presence of substandard and fake medications in LAC regions is a source of public health concern and causes an economic burden to the governments in these regions. Whereas testing and detecting medication quality can easily be achieved in developed countries, the situation is different in developing countries such as LAC. This paper aims to examine the public health challenges faced by LAC regarding substandard, fake and counterfeit medicines and how the region can tackle these challenges.

Databases such as Scopus, PubMed, ScienceDirect, Embase, HINARI, EBSCOhost, Google Scholar, unpublished data, conference abstracts and papers from World Health Organization, Pan-American Health Organization and electronic newspapers were searched concerning medicine quality and in LAC.

Drug treatment improves the quality of life while decreasing morbidity and mortality among diseased populations. Absence of or inadequate testing laboratories, old and ineffective legislature, lack of enforcement or willpower and lack of effective surveillance are challenges in LAC for the proliferation of substandard and falsified medicines (SFMs).

The most significant limitation of this study was the need for the reviewers to have used articles written in other languages besides English. The LAC region has a large population in non-English-speaking countries, and many articles are written using local languages. Hence, excluding those articles is a limitation worthy of note in this review. The articles accessed needed to provide adequate information on SFM markets and illegal pharmacies or hospitals but did not. Future reviews may focus on providing illegal substandard and falsified medicines markets in the region and how they can be minimized or eliminated.

This review highlights the challenges faced by LAC countries regarding substandard, fake and counterfeit medicines. The sources, prevalence and consequences of substandard and falsified drugs were identified to suggest the measures needed to curb the infiltration of low-quality medicines in LAC.

This paper aims to explore the role of tramadol in pain management and the impact of regulatory measures on supply and medical access in Ghana and other African countries.

The study adopted an exploratory design and qualitative methods to explore the perspectives of different actors, including officials of regulatory agencies, law enforcement agents, health-care providers and non-medical tramadol users. Data were collected through individual and group interviews, and transcripts were subjected to thematic analysis.

Findings show that tramadol fills a critical gap in treating pain across Ghana in areas with an acute shortage of opioid analgesics due to scheduling-related barriers. This was partly due to porous borders allowing for an influx of tramadol into the countries. The study further found that most tramadol purchases in Ghana and other West African countries were made from market traders rather than from health-care settings and were mainly generic medicines categorised as “substandard/spurious/falsely-labelled/falsified/counterfeit medical products” within the World Health Organization standards.

Although the findings are instructive, there were some limitations worth noting. The study encountered several limitations, especially with the non-medical users, because the environment is highly criminalised, People who use drugs were unwilling to avail themselves for fear of law enforcement officers’ harassment. Obtaining ethical clearance had its own bureaucracy – challenges that delayed the study time frame.

Placing tramadol under the list of internationally controlled substances would create barriers to access to effective pain medications, particularly by the poor, and encourage victimisation of users by law enforcement authorities.

The study is based on empirical research on tramadol use and regulation in African countries, contributing to knowledge in an under-researched subject area on the continent. The comparative approach further adds value to the research.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.