Public and prescriber perceptions of pharmaceutical pollution

20th February 2025

Research exploring eco-directed sustainable prescribing has found that while awareness is increasing among healthcare professionals and the public, further education is required on the drivers, potential effects and possible interventions – of which the results highlighted several for consideration.

Medications contribute substantially to pharmaceutical pollution, impacting both ecological health and public safety. Growing environmental concerns about this issue highlight the need for more sustainable prescribing practices that minimise environmental harm while ensuring effective patient care.

This study examined public and prescriber perceptions of pharmaceutical pollution in Scotland’s water environment, with a focus on eco-directed sustainable prescribing as a strategy to mitigate this pollution.

Semi-structured qualitative interviews were conducted with nine members of the public and 17 prescribing healthcare professionals to explore perceptions, barriers and opportunities for implementing eco-directed sustainable prescribing practices.

Public participants recognised the environmental issues related to pharmaceutical pollution but stressed the need for further education on the topic. They suggested that pharmacy-specific interventions should include targeted messaging and informative displays at the point of care, clearer labelling on medications to highlight their environmental impact and better access to pharmacy return schemes for unwanted medicines.

Additionally, a more person-centred approach, with an emphasis on regular medication reviews and deprescribing, was seen as useful.

While participants were open to environmentally friendly alternatives, they emphasised that any change to prescriptions should not compromise their effectiveness. They preferred to make informed decisions based on clear, accessible information and discussions with prescribers.

Prescribers also agreed that pharmaceutical pollution should be incorporated into their training. They noted that similar conversations already occurred around changes such as inhaler switches and that eco-directed sustainable prescribing could align with these efforts.

They also emphasised the need for effective multidisciplinary communication and for accessible tools, such as environmental sections in formularies and integrated decision-support in prescribing systems. Key strategies for advancing sustainable prescribing included regular prescription reviews and shorter courses of treatments where possible.

The authors noted the need for healthcare to ‘undergo fundamental changes’ to create more sustainable medicines use practices, although they did acknowledge the difficulties in translating recommendations from prescribers and the public into policy.

Nevertheless, they highlighted ‘the need for accessible and robust knowledge support tools to enable [eco-directed sustainable prescribing], which should be underpinned by policy guidance and embedded into existing systems.’

And they championed cross-sector and transdisciplinary collaborative approaches to overcome the challenges for achieving this.

Further research will be needed to evaluate the long-term effects of eco-directed sustainable prescribing on both environmental health and patient outcomes, they concluded.

Reference
Niemi L, et al. Do you think medicines can be prescribed in a more eco-directed, greener way? A qualitative study based on public and prescriber focus groups on the impact of pharmaceuticals in Scotland’s water environment. BMJ Open. 2025 Jan 20;15(1):e088066. doi: 10.1136/bmjopen-2024-088066.

This article was originally published by our sister publication Hospital Pharmacy Europe.

Deprescribing intervention safe and effective for reducing medication burden

8th February 2023

A deprescribing intervention that was either nurse- or pharmacist-led was both safe and effective at reducing medication burden

A randomised trial of a patient-centred deprescribing intervention in older adults led to a significant reduction in medicine use compared to a control group who did not receive the intervention according to a study by US researchers based in Tennessee.

Polypharmacy is defined by the use of five or more medicines and one US study found that in 2010, among elderly patients (65 years and older), polypharmacy was present in 39% of cases. Polypharmacy increases the risk of adverse drug reactions and somewhat alarmingly in one analysis of 2,105 older adults discharged from hospital, 74% were prescribed a polypharmacy regimen.

Consequently, deprescribing interventions to reduce medication burden are likely to decrease the risk subsequent adverse events associated with the use of multiple treatments. In the current study, the US team examined the effectiveness of a deprescribing framework at reducing medication burden. The intervention had been previously piloted in one centre and was found to be effective, leading to US to undertake randomised, controlled trial of the intervention.

The intervention itself involved nurses or pharmacists reviewing the medicines of older adults prior to hospital discharge to a post-acute care (PAC) facility and the outcomes compared with the usual hospital discharge care.

The primary outcome was the total medication count at hospital and PAC discharge and participants were followed-up for assessment, 90 days after being discharged from the PAC facility. Secondary outcomes included the total number of potentially inappropriate medications (PIMs) as well as the drug burden index (DBI) which measured sedative and anticholinergic burden.

Deprescribing intervention and total medication burden

A total of 284 participants (142 per group) with a mean age of 76.2 years (62% female) were included in the final analysis and the median length of PAC facility stay was 22 days. Overall, the median number of prehospital medications per patient was 16.

As a result of the intervention, participants were taking a mean of 14% fewer medications upon discharge from the PAC facility (mean ratio, MR = 0.86, 95% CI 0.80 – 0.93, p < 0.001). In addition, at the 90-day assessment, those previously assigned to the intervention were taking 15% fewer medicines (MR = 0.85, 95% CI 0.78 – 0.92, p < 0.001) compared to the control group.

The intervention group were also prescribed fewer PIMs and had a lower DBI after 90 days yet the incidence of adverse drug events was similar between the intervention and control groups (hazard ratio, HR = 0.83, 95% CI 0.52 – 1.30).

The authors concluded that their deprescribing intervention was both safe and effective at reducing overall medication burden and called for future studies to examine the impact of the intervention on both patient-reported and long-term clinical outcomes.

Citation
Vasilevskis EE et al. Deprescribing Medications Among Older Adults From End of Hospitalization Through Postacute CareA Shed-MEDS Randomized Clinical Trial. JAMA Intern Med 2023.