Reducing pressurised metered dose inhaler prescriptions for asthma to reduce carbon emissions: a qualitative study of healthcare professional perspectives.

Abstract

Background: Prescribing of pressurised metered dose inhalers (pMDIs) is a key NHS carbon hotspot and reducing the number of these devices prescribed will help achieve NHS net zero targets.

Aim: To explore primary healthcare professionals' perspectives on reducing the prescribing of pMDIs for people with asthma to reduce associated carbon emissions.

Design & setting: Qualitative study of healthcare professionals (general practitioners, practice nurses and clinical pharmacists) working in general practice in England.

Method: Eighteen semi-structured interviews were conducted with healthcare professionals. Participants were recruited through professional networks and using snowball sampling. Topic guides were developed to explore participant perspectives, concerns and motivations.

Results: Eight general practitioners, six practice nurses and four clinical pharmacists were interviewed. Results are presented over two topics. The first explores factors influencing inhaler device choice and discusses the themes: patient-centred care, bias and assumptions, clinician confidence and knowledge, and status quo of asthma care. The second topic identifies facilitators and barriers for prescribing fewer pMDIs through the themes: understanding, attitudes to change, confidence in DPIs, engagement with sustainable prescribing, the role of incentives, and guidelines and systems.

Conclusion: Interlinking personal, consultation and external factors influence which inhaler device is prescribed for patients with asthma. There are significant actionable barriers to implementing carbon-conscious prescribing, many of which would improve the quality of asthma care.