Greener Asthma Prescribing Study: A qualitative study exploring healthcare professional perspectives on reducing the prescribing of metered dose inhalers for asthma to reduce the carbon footprint of primary care

Problem

Climate change is the single greatest threat to human health. In 2020, the NHS developed its net-zero goals and highlighted pressured metered dose inhalers (pMDIs) as a focal point for change. pMDIs are commonly prescribed for asthma in primary care and contain potent greenhouse gases, accounting for 3% of the entire NHS carbon footprint. Ways to reduce pMDI prescribing include tackling over-reliance on short-acting beta-agonists, optimising inhaler technique and reducing waste and switching to dry powder inhalers, which have a lower carbon footprint. Despite there being policy targets to reduce pMDI prescribing and clinical guidance to support greater use of DPIs, there is little evidence to support the implementation of this guidance and realisation of these targets in primary care. It is also unknown whether primary care clinicians have any apprehension about these prescribing changes.

This study aims to explore healthcare professional perspectives on reducing the prescribing of pMDIs for people with asthma to reduce the carbon footprint of primary care.

The study objectives are:

- To explore practice nurses, GPs and clinical pharmacist perspectives on what influences their decisions on prescribing of asthma inhalers and how these decisions are made within a consultation.

- To explore primary health care professionals’ awareness of the environmental impact of pMDIs and how this influences their behaviour.

- To explore primary health care professionals’ beliefs, motivations, concerns and confidence around switching to lower global warming potential (GWP) inhalers.

Approach

We conducted semi-structured interviews with general practitioners, practice nurses and clinical pharmacists from general practices across the North of England and West Midlands. The interviews were carried out via Microsoft Teams. The topic guide was developed with input from patients with asthma, and from HCPs from each professional group and was iteratively developed as interviews progressed, using a constant-comparative approach. Interviews were audio-recorded and transcribed. Data is currently being analysed using thematic analysis via NVivo 12.

Findings

Early findings suggest that primary healthcare professionals are aware of the carbon emissions associated with inhalers and have been encouraged within their PCNs to prescribe more DPIs. Time, burn-out and fear of patient refusal, have been identified as barriers preventing clinicians from changing their prescribing habits. Where prescribing changes did occur, financial incentives, such as the inclusion of DPI targets within the IIF, were identified as the key driver for change. Full findings will be presented at the conference.

Consequences

This research provides a greater understanding of the perspectives of primary care clinicians on sustainable healthcare and the factors that influence inhaler prescribing. It emphasises the role of financial interventions in changing prescribing habits and highlights the barriers that need to be overcome in clinical practice to achieve the NHS’ carbon net-zero goals.