Abstract
Of the drug distribution models implemented in the Italian National Healthcare Service provided to guarantee the administration of medication, the drug distribution performed through the hospital channel is an operative strategy that allows for savings in the public expenditure, but often creates higher social costs for patients and caregivers. This distribution model leads to high access to hospitals which, during pandemics, amplifies the risk of contagion, making these healthcare facilities a place where epidemics could spread and negatively affect high-risk patients. Considering their extensive local presence, primary care services and community pharmacies could play an active role to reach patients and ensure the proper distribution of drugs. Based on the differences in these two distribution models, a prescriptive tool could provide suggestions for the institutional decision-making process. When performed by different stakeholders (i.e., policy makers, health authorities or agencies), it could define which drugs should be distributed by primary care pharmacies for the treatment of chronic diseases and provide an answer to critical issues in case of future pandemic situations and healthcare emergencies. Prescriptive data analyses are known as the best methods for formulating prescriptions in the distribution field and constrained optimization sets the values of decision variables to achieve specific objectives, such as a reduction in the number of visitors to the hospital setting. Grounded on previous research in this field, the present study proposes a decision support tool based on a constrained optimization model, establishing which drugs currently dispensed by hospital pharmacies should be distributed by primary care pharmacies. This approach allows for limiting crowding and balances the distribution costs to guarantee equal access to care for patients. The model structure and the possible decision-making outputs reached by applying the prescriptive tool are discussed and the “what-if” analysis is used to ensure the robustness of the simulation approach.
