Developing frameworks for eco-directed sustainable prescribing: Towards reducing environmental pollution from healthcare practices
Lead Research Organisation:
NHS Highland
Department Name: Public Health
Abstract
The prescription of a medicine to diagnose, treat, cure, and prevent disease is the most common intervention in healthcare - but this activity negatively impacts the environment, and pharmaceutical pollution is now a well-recognised global public health and environmental issue. Antibiotics, anti-inflammatories, antidiabetics, and antidepressants in surface water can negatively affect aquatic organisms, causing feminisation and reproductive failure, physiological and behavioural changes, immunodeficiency, and assistance in the spread of antimicrobial resistance (AMR - a critical public health issue). Healthcare sustainability targets call for improvements to prescribing and medicine selection, as current practices are environmentally, economically, clinically, and socially unsustainable. Improving medicine selection, use, and disposal can reduce pharmaceutical pollution from healthcare.
This project seeks to develop and evaluate, for the first time in the UK, an eco-directed prescription framework that incorporates environmental sustainability alongside clinical and cost effectiveness. This proposes that if pharmaceuticals are of comparable medical efficacy, safety, and effectiveness, then the environmental impact (e.g., drug ecotoxicity, predominance towards AMR) should be considered during the formulary process to better inform prescribers, enabling them to make more sustainable prescribing choices.
The research investigators (representing NHS Highland, University of Nottingham, and the Environmental Research Institute-University of the Highlands and Islands) have strong track-records and expertise in pharmaceutical public health, formulary development, qualitative health services research, environmental science, and cross-sector collaboration. The project will capitalise on the established networks and resources of national and international partners representing key stakeholders across the healthcare, prescribing, environment, and water sectors, including the Scottish One Health Breakthrough Partnership - a globally unique, cross-sector group which created an interactive visualisation tool comparing environmental pharmaceutical data and prescribing rates in Scotland (a world first) to progress prioritisation of formulary changes. Investigators will: interrogate environmental and prescribing data; evaluate ecotoxicological data for environmental hazard indicators; prioritise criteria through structured consensus and focus group activity; develop a robust decision-making formulary framework through novel application modelling techniques; and, engage with patients, practitioners, and prescribers to assess suitability. The investigators will work with networks/stakeholder groups to disseminate, educate, and develop post project activity for a pilot trial towards implementation. This project will meet the opportunities and challenges of this call, whilst also: enhancing research sustainability and generating innovation; integrating novel research methods; ensuring genuine PPI and cross-sector stakeholder engagement; supporting high-level dissemination and impact; and creating additionality through next-stage project planning of the framework, which can be piloted post-project and adopted at UK- and international-level.
This project will be an innovation-first for the UK, identifying novel methods and data required for eco-directed prescribing and leading to new understanding and awareness of the environmental impact of pharmaceutical prescribing. It will create opportunities for a 'step change' in practice that improves the quality of medicine prescribing and use in Scotland, and benefits the NHS, practitioners/prescribers and patients through enabling better informed and more sustainable prescribing and medicine choices. The project will contribute to reduced environmental pollution from medicines, address sustainability targets, address biodiversity loss and AMR, and promote better health now and for the future.
This project seeks to develop and evaluate, for the first time in the UK, an eco-directed prescription framework that incorporates environmental sustainability alongside clinical and cost effectiveness. This proposes that if pharmaceuticals are of comparable medical efficacy, safety, and effectiveness, then the environmental impact (e.g., drug ecotoxicity, predominance towards AMR) should be considered during the formulary process to better inform prescribers, enabling them to make more sustainable prescribing choices.
The research investigators (representing NHS Highland, University of Nottingham, and the Environmental Research Institute-University of the Highlands and Islands) have strong track-records and expertise in pharmaceutical public health, formulary development, qualitative health services research, environmental science, and cross-sector collaboration. The project will capitalise on the established networks and resources of national and international partners representing key stakeholders across the healthcare, prescribing, environment, and water sectors, including the Scottish One Health Breakthrough Partnership - a globally unique, cross-sector group which created an interactive visualisation tool comparing environmental pharmaceutical data and prescribing rates in Scotland (a world first) to progress prioritisation of formulary changes. Investigators will: interrogate environmental and prescribing data; evaluate ecotoxicological data for environmental hazard indicators; prioritise criteria through structured consensus and focus group activity; develop a robust decision-making formulary framework through novel application modelling techniques; and, engage with patients, practitioners, and prescribers to assess suitability. The investigators will work with networks/stakeholder groups to disseminate, educate, and develop post project activity for a pilot trial towards implementation. This project will meet the opportunities and challenges of this call, whilst also: enhancing research sustainability and generating innovation; integrating novel research methods; ensuring genuine PPI and cross-sector stakeholder engagement; supporting high-level dissemination and impact; and creating additionality through next-stage project planning of the framework, which can be piloted post-project and adopted at UK- and international-level.
This project will be an innovation-first for the UK, identifying novel methods and data required for eco-directed prescribing and leading to new understanding and awareness of the environmental impact of pharmaceutical prescribing. It will create opportunities for a 'step change' in practice that improves the quality of medicine prescribing and use in Scotland, and benefits the NHS, practitioners/prescribers and patients through enabling better informed and more sustainable prescribing and medicine choices. The project will contribute to reduced environmental pollution from medicines, address sustainability targets, address biodiversity loss and AMR, and promote better health now and for the future.
Technical Summary
The prescription of a medicine is the most common intervention in healthcare - but this activity negatively impacts the environment, and pharmaceutical pollution is now a well-recognised global public health and environmental issue. Healthcare sustainability targets call for improvements to prescribing and medicine selection, as current practices are unsustainable. Improving medicine selection and use can reduce pharmaceutical pollution from healthcare. This project will develop and evaluate an eco-directed prescription framework that incorporates environmental sustainability with clinical and cost effectiveness. This proposes that if pharmaceuticals are of comparable medical efficacy, safety, and effectiveness, then the environmental impact (e.g., drug ecotoxicity, predominance towards AMR) should be considered during the formulary process to better inform prescribers, enabling them to make more sustainable prescribing choices. The research investigators will: interrogate environmental and prescribing data; evaluate ecotoxicological data and drug physicochemical properties to develop environmental hazard indicators; prioritise criteria through structured consensus and focus group activity; develop a robust decision-making formulary framework through novel application of Bayesian Belief Network modelling; and, engage with patients, practitioners, and prescribers to assess suitability. The investigators will work with project partners and networks/stakeholder groups to disseminate, educate, and develop post project activity for a pilot trial towards implementation. This project will meet the opportunities and challenges of this call, whilst also: enhancing research sustainability and generating innovation; integrating cross-sector research methods; ensuring genuine PPI and cross-sector stakeholder engagement; supporting high-level research impact within and beyond the environment-healthcare sectors; and addressing environmental pollution from healthcare practices.
| Description | House of Lords - Consultation events towards developing a bill to reduce and/or precent pharmaceutical pollution in the UK |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| URL | https://bsac.org.uk/wp-content/uploads/2023/07/Fina-Digital_Policy-Brief-on-EDSP_18Jul23.pdf |
| Description | NHS Scotland CLEAN Sustainable Care subgroup |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | Policy Brief - Eco-directed and Sustainable Prescribing of Pharmaceuticals in the United Kingdom |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| URL | https://bsac.org.uk/wp-content/uploads/2023/07/Fina-Digital_Policy-Brief-on-EDSP_18Jul23.pdf |
| Description | Postgraduate course: Pharmaceuticals in the Environment |
| Geographic Reach | Europe |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | According to the course website: In the first edition (November 2022- June 2023) there were 10 students registered, from 3 different nationalities (Spain, Mexico and Germany). No data is available online on the final evaluation but after the first evaluation period corresponding to November 2022-March 2023, the average grade obtained by the students was 8 points out of a maximum of 10 in a test that assess the acquisition of specific skills related to this subject. |
| URL | https://eafponline.eu/education/postgraduate-course-on-pharmaceuticals-in-the-environment/ |
| Description | Postgraduate course: Pharmaceuticals in the Environment (2024) |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| URL | https://www.ehu.eus/es/web/graduondokoak/experto-universidad-farmacontaminacion |
| Description | Scottish Government Climate Change and Sustainability Board |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Title | Database and Bayesian Network Model to generate pollution risk scores of pharmaceuticals in freshwater environments |
| Description | The model was developed through the mixed-methods approach including via cross-sector stakeholder consensus developmental techniques, and model co-creation with experts across the healthcare, prescribing, environment, and public health sectors. Nominal Group Technique (NGT) was applied to achieve consensus on pharmaceuticals and factors for inclusion in the model, working with cross-sector stakeholders representing the healthcare and environmental perspectives. Bayesian Belief Network (BBN) modelling was applied to predict the environmental impact (calculated from hazard and exposure factors ) of selected pharmaceuticals, with Scotland-wide GIS mapping for visualisation in freshwater catchments. The study achieved consensus on the pharmaceuticals and framework criteria. Selected pharmaceuticals included representatives of four classes: carbamazepine (anti-epileptic), clarithromycin (antibiotic), fluoxetine (antidepressant), and propranolol (beta-blocker). Expert consultation and literature review supported collation of the environmental hazard and exposure data of the selected pharmaceuticals, following a classification system based on physicochemical properties, ecotoxicity, national prescribing data, and wastewater treatment removal rates. The database was incorporated into a Scotland-wide BBN model, which calculated the pollution risk score of the selected pharmaceuticals, using the ratio of prescribed mass vs. mass that would not result in the exceedance of a 'safe' concentration in the freshwater environment, defined as the predicted no-effect concentrations (PNEC). The pharmaceuticals exhibited different risk patterns, and spatial variation of risk was evident (generally related to population), with the highest number of catchments predicted to exceed the pollution risk score for clarithromycin (probability >80% in 33 of 40 modelled catchments. Simulated risk score was compared against observed risk calculated as the ratio of predicted environmental concentrations and measured environmental concentrations from an open-access Scottish database, finding that the model was generally overpredicting risk, likely due to missing factors (e.g. solid-phase sorption, temporal variation) and low temporal resolution of the available measured environmental concentrations. |
| Type Of Material | Computer model/algorithm |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | The publication on this model is under development (expected April 2024), and will be published open-access following MRC guidelines. The model will be further refined and adapted for a 4yr, £2million NERC funded project "MOT4Rivers: Monitoring, modelling and mitigating pollution impacts in a changing world: science and tools for tomorrow's rivers", led by the University of Stirling (Scotland) with Scottish and English HEIs under the UK Freshwater projects 2022-26. The model will be further refined and used for the Scottish Government's RESAS funded 5yr project "Emerging Water Futures" led by the James Hutton Institute (Scotland). |
| URL | https://ohbp.org/outputs/projects/developing-frameworks-for-eco-directed-sustainable-prescribing/ |
| Description | "Developing sustainable prescribing models to reduce environmental pollution from medicines - Exploring Pharmacists' perceptions" |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Two members of the research team (Prof Sharon Pfleger and Dr Naoko Arakawa) submitted an abstract and were successful in hosting the workshop at the European Society of Clinical Pharmacy conference 2023. The workshops (2 hrs) ran twice throughout the conference, and aimed to educate participants on the issue of pharmaceutical pollution in the water environment, and sustainable prescribing methods to reduce environmental pollution from medicines and to obtain their views on the issue. It included introductory presentations on the issue of pharmaceutical pollution and the outputs from the MRC funded research project "Developing frameworks towards eco-directed sustainable prescribing". Participants completed two online quizzes to assess background knowledge and interest in this topic, and perceptions on sustainable prescribing and how environmental information could be incorporated into current prescribing practices. Workshop participants were prompted with four questions, and an interactive Padlet was used to collate open-ended responses as the number of participants precluded full discussion. The outcomes from the Padlet were compared to outcomes from the prescriber and public focus group workshops hosted during the MRC project. The audience was engaged throughout the workshops, and many questions were asked about the issue of pharmaceutical pollution, patient education/awareness, pros/cons of including environmental information in prescribing decision making, and feasibility of sustainable prescribing. Several requested information from the PI and Co-I, in order to raise awareness and disseminate to their networks. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://escpweb.org/escp_events/aberdeen-symposium-2023/ |
| Description | 81st International Pharmaceutical Federation World Congress |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Research team Co-I (Naoko Arakawa) presented the poster "Developing stakeholder consensus regarding priority pharmaceuticals and environmental risk criteria for formulary decision making: Nominal Group Technique" at the 81st International Pharmaceutical Federation World Congress (Brisbane). This poster presented the results of the cross-sector stakeholder workshops which were used to reach consensus on pharmaceuticals and environmental impact data to include in developing the framework for eco-directed prescribing formulary decision making. The poster was well-received and sparked discussion amongst conference participants on including environmental experts in healthcare decision-making. FIPs mission is to support global health by advancing pharmaceutical practice, science and workforce & education, and the poster aligned well with the ethos and theme "Pharmacy building a sustainable future for healthcare". |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://brisbane2023.fip.org/ |
| Description | 81st International Pharmaceutical Federation World Congress |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Research team Co-I (Claire Anderson) presented the poster "Do you think medicines can be prescribed in an eco-friendly, greener way" at the 81st International Pharmaceutical Federation World Congress (Brisbane). This poster presented the results of the public focus groups, which identified public perceptions and attitudes towards pharmaceutical pollution and sustainable prescribing in Scotland. The poster was well-received and sparked discussion amongst conference participants on themes including shared-decision making, patient education, and the pros/cons of including environmental aspects in prescribing practice. FIPs mission is to support global health by advancing pharmaceutical practice, science and workforce & education, and the poster aligned well with the ethos and theme "Pharmacy building a sustainable future for healthcare". |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://brisbane2023.fip.org/ |
| Description | British Geriatrics Society |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Prof Sharon Pfleger (PI) delivered the presentation "The environmental impact of medicines used by Older people", for the event in Edinburgh. This showcased the cross-sector collaborative project and healthcare data and resources which were utilised for the MRC project. Outputs from the MRC project were promoted, highlighting the importance of transdisciplinary work to drive impact and develop solutions to address complex environmental issues. The audience was engaged throughout and many questions were asked about the issue of pharmaceutical pollution, implications of polypharmacy, and pros/cons of sustainable prescribing. The main outcomes included increased awareness of the environmental impact of healthcare practices in relation to polypharmacy, and the tools/resources needed to develop more sustainable healthcare practices. |
| Year(s) Of Engagement Activity | 2023 |
| Description | British Pharmaceutical Students' Association Climate Change Campaign |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | Dr Naoko Arakawa (Co-I) delivered the presentation "Greener prescribing and the eco-directed formulary" to showcase the MRC project outputs and cross-sector collaboration to develop more sustainable prescribing practices. The BPSA Climate Change Campaign event was hosted by the British Pharmaceutical Students' Association (representing British pharmacy students and pre-registration pharmacists), and aimed to improve understanding and awareness of the role future pharmacists can take to help tackle climate-related challenges for a greener, more sustainable healthcare future. The audience was engaged throughout the presentation, and lively discussion followed on including environmental aspects in the pharmacy curriculum and training. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://www.bpsa.co.uk/ |
| Description | CleanMed Europe |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Prof Sharon Pfleger (PI) presented "Reducing threats from pharmaceuticals now and in the future ", showcasing the UKRI MRC funded project and new collaboration developed between healthcare, environmental science, and pharmacy to an international audience. She also promoted the project objectives and cross-sector stakeholder group brought together in developing a framework for an eco-directed formulary in Scotland. The presentation was followed by a Q&A session (Total 20 minutes - approximately 15 minute presentation and 5 minutes for questions). The audience was engaged throughout and many questions were asked about the issue of pharmaceutical pollution, developing the evidence base to include environmental aspects in healthcare decision making, and pros/cons of sustainable prescribing. Request for further information were made, and the PI identified potential collaborators for future activity. The theme of the conference was "Changing the climate on healthcare", and the transdisciplinary nature of the project aligned well with the theme. CleanMed is Europe's leading conference on sustainable healthcare and brings together healthcare leaders and champions of sustainability from across the region and beyond to share ideas, innovations, challenges, and solutions for sustainability in European healthcare. The conference showcases cutting-edge practices in sustainable healthcare and is the ideal venue for healthcare innovators to network and share ideas, finding new ways to drive change within their organisations and communities. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://events.hubilo.com/cleanmed-europe-2023/register |
| Description | Cross-sector stakeholder dissemination event and workshop "Towards eco-directed prescribing" |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | in October 2023, the MRC project research team, project partners, and wider stakeholder group came together at the Royal Pharmaceutical Society in Edinburgh (and online) for a cross-disciplinary dissemination and workshop event, to review project outputs and discuss next stage activity. The event facilitated engagement with relevant cross-sector stakeholders from environment, water industry, healthcare regulation, policy, and healthcare practitioners who do not normally meet to identify engagement opportunities and key links with policy, research and workstreams related to sustainable healthcare and pharmaceuticals in the environment. Event attendees (63 total) included representatives across the healthcare, prescribing, environment, medicines regulation, public health and pharmaceutical industry sectors, as well as researchers in environmental science and qualitative research methods. Invited presentations took place during the morning session, covering background of the issue of pharmaceuticals in the environment, MRC project outputs, and partnership work through the One Health Breakthrough Partnership (a collaboration of cross-sector stakeholders in the water industry, environmental sector and healthcare sector to develop sustainable solutions to reduce the environmental impact of healthcare practices). The morning session was followed by a workshop to develop follow-on activity on eco-directed sustainable prescribing and solutions to pharmaceuticals in the environment in Scotland. The workshop focussed on progressing activity into eco-directed prescribing, following outcomes and recommendations from the MRC project, including: Accessing clinical data; Capturing environmental data; and, Informing qualitative studies. The participants were engaged throughout the day, and new networks were created by brining together cross-sector multi-disciplinary researchers and stakeholders, particularly those from healthcare and environment sectors who do not normally connect. The MRC research team and project partners (including One Health Breakthrough Partnership) will use the recommendations and collaborative opportunities identified through the MRC project and workshop to develop next stage project plans. Stakeholders from the MRC project with relevant expertise and interest, will also be considered for further collaborative activity. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://ohbp.org/2023/10/13/ohbp-participate-in-mrc-end-of-project-event-workshop/ |
| Description | Ethical Medicines Industry Group (Edinburgh) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Prof Sharon Pfleger (PI) delivered the presentation "A partnership approach to nontoxic sustainable healthcare" to the Ethical Medicines Industry group, and showcased the cross-sector collaborative project and healthcare data and resources which were utilised for the MRC project. The collaborative MRC funded project to develop an eco-directed formulary was promoted, highlighting the importance of transdisciplinary work to drive impact and develop solutions to address complex environmental issues. The audience was engaged throughout and discussed working with environmental scientists/experts to improve environmental considerations during healthcare decision making, and the feasibility of sustainable prescribing. The main outcomes included increased awareness on the tools/resources needed to develop more sustainable healthcare practices, and the impact which healthcare and environmental sectors can achieve when working together. |
| Year(s) Of Engagement Activity | 2023 |
| Description | European Health Management Association's webinar and white paper launch event |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Prof Sharon Pfleger (research team PI) contributed to development of EHMA's White Paper "Reducing the environmental impact of medicines: From Procurement to Disposal", and participated in the expert panel launch event alongside health managers and policy advisors in environment policy, healthcare, public affairs and sustainability. The PI's presentation promoted the new collaboration developed between healthcare, environmental science, and pharmacy to an international audience, and promoted project activity and cross-sector engagement in developing a framework for an eco-directed formulary in Scotland. The audience was engaged throughout and discussed recommendations for health managers to reduce the environmental impact of medicines, feasibility of including environmental criteria in healthcare decision making, and ethical considerations with respect to sustainable prescribing and healthcare. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://ehma.org/reducing-the-environmental-impact-of-medicines-from-procurement-to-disposal/ |
| Description | European Meeting on Environmental Chemistry - Presentation |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Dr Lydia Niemi (research Co-I) delivered the presentation "Innovative Data Visualisation Tool to Aid Understanding Pharmaceutical Pollution in the Environment" at the environmental science conference, and showcased the healthcare data and resources which were utilised for the MRC project against objectives to develop the environmental risk model for pharmaceuticals in the water environment in Scotland (as the formulary framework). The collaborative MRC project was promoted, highlighting the importance of transdisciplinary work to drive impact and develop solutions to address complex environmental issues, such as reducing healthcare's impact on the environment and meeting NHS sustainability goals. The audience was engaged throughout, and asked questions about the data sources and methods to develop the environmental risk modelling, as well as how healthcare professionals have responded to this work. The main outcomes included increased awareness on the tools/resources needed to develop more sustainable healthcare practices, and the impact which healthcare and environmental sectors can achieve when working together. The conference also offered the RCo-I an opportunity to engage with international networks in environmental science and develop collaborative activity. |
| Year(s) Of Engagement Activity | 2022 |
| Description | International Pharmaceutical Federation webinar - Ethics of Sustainable Healthcare |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Prof Sharon Pfleger (PI) presented "Thinking beyond the patient: What is the pharmacy profession's duty of care to the wider population and the planet" at the FIP webinar Ethics of Sustainable Healthcare. The presentation showcased the MRC project as an example of cross-sector knowledge exchange and research activity that is needed for pharmacy to develop innovative solutions to complex environmental issues. The presentation was attended by pharmacists, allied healthcare professionals, early careers practitioners, and researchers, and the Q&A provided an opportunity to discuss ethical considerations with respect to sustainable prescribing and healthcare for current and future generations. The audience was engaged throughout and discussed including of environmental criteria in healthcare decision making. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://networks.sustainablehealthcare.org.uk/events/fip-webinar-ethics-sustainable-healthcare |
| Description | Prescriber focus groups workshops |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Two focus groups with NHS Scotland prescribers were hosted online to assess the awareness and perceived importance of pharmaceutical pollution in the environment, and sustainable prescribing methods. Purposive and opportunistic sampling approaches were used to recruit participants through social media and other communication channels (i.e., community groups, professional email, GP and hospital flyers). A total of 17 NHS Scotland prescribers with a range of professional backgrounds, years of prescribing experience, and from a variety of sectors and health boards were recruited into each of the two prescriber focus groups. A short introductory presentation was given on the background and significance of pharmaceutical pollution in the environment, the purpose of the study, and then a wide-ranging discussion was facilitated. A range of common questions were asked, and the semi-structured nature of the interviews ensured that all participants had the opportunity to fully reflect on their experiences and contribute to the discussion. The audience was engaged throughout the workshops, and many questions were asked about the issue of pharmaceutical pollution, importance of patient involvement/education, feasibility of sustainable prescribing in practice, and preferences in information communication. Several participants noted that this was not an issue they had been aware of previously, and they requested further information and access to project outputs to raise awareness and disseminate in their networks/practices. Most of the participants reported a change in views about prescribing, and they would like to adopt more sustainable practices and see further education about this issue and clear guidance about recommendations for more sustainable prescribing. Following the focus groups, Dr Lydia Niemi (as representative of the research team) was asked to deliver a module on pharmaceutical pollution and the outcomes from the MRC project for NHS Scotland's CPD webinar week on (February 2024). |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://ohbp.org/2023/07/17/mrc-project-researchers-advertising-for-prescriber-focus-group-online/ |
| Description | Public Health Workshop - UK/Germany exchange British Embassy |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Third sector organisations |
| Results and Impact | Sharon Pfleger (Research team PI) participated in the British Council funded knowledge exchange workshop with stakeholders across academia, government and healthcare from the UK, Germany and internationally on nature based and social prescribing. Prof Pfleger delivered a presentation "Nature based social prescribing, a golden opportunity to turn the tide on medicines harm" and participated in an expert panel session on social and sustainable prescribing. The workshop included interactive activities to develop pragmatic nature based social prescribing in terms of evidence, policy, intervention and the health system. The PI's presentation promoted the new collaboration developed between healthcare, environmental science, and pharmacy in Scotland, and promoted project activity and cross-sector engagement in developing a framework for an eco-directed formulary. The audience was engaged throughout and discussed recommendations for nature-based and social prescribing to reduce the environmental impact of medicines, feasibility of including environmental criteria in healthcare decision making, and ethical considerations with respect to sustainable prescribing and healthcare. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Public focus group workshops |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Public/other audiences |
| Results and Impact | Public focus groups were hosted in-person in Inverness (Scotland) to assess the awareness and perceived importance of pharmaceutical pollution in the environment, and sustainable prescribing methods. Purposive and opportunistic sampling approaches were used to recruit participants through social media and other communication channels (i.e., community groups, professional email, GP and hospital flyers). A total of 12 members of the public attended the focus groups. A short introductory presentation was given on the background and significance of pharmaceutical pollution in the environment, the purpose of the study, and then a wide-ranging discussion was facilitated. A range of common questions were asked, and the semi-structured nature of the interviews ensured that all participants had the opportunity to fully reflect on their experiences and contribute to the discussion. The participants were engaged throughout the workshop, and a wide ranging and rich discussion followed. This included themes about who is responsible for addressing pharmaceutical pollution, how patients can access pharmacy disposal schemes, the importance of prescriber-patient relationships and patient education, and the feasibility of sustainable prescribing in practice. Several participants noted that this was not an issue they had been aware of previously, and they requested further information and access to project outputs to inform themselves and their networks about this issue. Many reported changes in views about using pharmacy disposal schemes and medicine stockpiling. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://ohbp.org/2023/04/04/mrc-project-researchers-advertising-for-public-focus-group-in-inverness/ |
| Description | RCGP and RPS - Sustainable Prescribing roundtable |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Dr Lydia Niemi (research Co-I) delivered the presentation "Developing frameworks towards sustainable prescribing" to showcase the MRC funded project to professional bodies, and promote the need for cross-sector engagement and transdisciplinary approaches to address complex environmental issues and meet NHS sustainability targets. The audience included healthcare professionals and members of the Royal College of General Practitioners and Royal Pharmaceutical Society (Scottish contingent of the national bodies). The audience was engaged throughout the presentation, and lively discussion followed about the issue of pharmaceutical pollution, developing the evidence base to include environmental aspects in healthcare decision making, and feasibility of sustainable prescribing in practice. One outcome included that members of RCGP and RPS joined the cross-sector project stakeholder group to keep up to date on progress of the MRC project and provide feedback on the outputs. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://www.rcgp.org.uk/news/scotland-greener-prescribing#:~:text=Last%20year%2C%20RCGP%20and%20RPS,... |
| Description | Scottish Intercollegiate Guidelines Network |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Prof Sharon Pfleger (PI) presented "The environmental impact of medicines - reducing the impact one prescription at a time", showcasing the UKRI MRC funded project and new collaboration developed between healthcare, environmental science, and pharmacy. The event was focussed on evidence-based medicine and guidance, and participants included hospital doctors, GPs, pharmacists, nurses, allied healthcare professionals, early careers practitioners and all those with an interest in evidence-based medicine. The presentation was followed by a Q&A session (Total 20 minutes - approximately 15 minute presentation and 5 minutes for questions), the audience was engaged throughout and many questions were asked about the issue of pharmaceutical pollution, developing the evidence base to include environmental aspects in healthcare decision making, and pros/cons of sustainable prescribing. Request for further information were made, and the PI identified potential collaborators for future activity. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://events.rcpe.ac.uk/sign30-adapt-or-die-clinical-guidelines-and-infodemic |
| Description | Scottish Practice Pharmacy and Prescribing Advisors Conference |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Prof Sharon Pfleger (research team PI) delivered the presentation "Environmental Sustainability in Pharmacy" at the Scottish Practice Pharmacy and Prescribing Advisors conference, promoting the MRC funded project to develop an eco-directed prescription formulary in Scotland. The presentation aimed to increase awareness and knowledge on the issue of pharmaceutical pollution in the environment and the environmental impact of healthcare practices. The audience was engaged throughout, and the presentation was followed by questions and discussion with the audience on the issue of pharmaceutical pollution and the opportunities for most sustainable pharmacy. Many noted increased awareness of the need to adapt healthcare practices to respond to environmental crises and sustainability calls. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Society of Environmental Toxicology and Chemistry (SETAC) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Dr Lydia Niemi (research Co-I) delivered the presentation "Innovative Data Visualisation Tool to Aid Understanding Pharmaceutical Pollution in the Environment" at the environmental science conference (SETAC). Tee presentation showcased the healthcare data and environmental monitoring data and other resources which were utilised for the MRC project objective in developing the environmental risk model for pharmaceuticals in the water environment in Scotland. The MRC funded project was promoted, highlighting the importance of transdisciplinary and cross-sector collaboration between environmental science, health services research, and healthcare sector to drive progress towards achieving the NHS sustainability goals and develop solutions to address complex environmental issues. The main outcomes included increased awareness of the tools/resources needed to develop more sustainable healthcare practices in the UK, and the impact which healthcare and environmental sectors can achieve when working together. The conference also offered the RCo-I an opportunity to engage with international networks in environmental science and develop collaborative activity. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://europe2023.setac.org/ |
| Description | TRANSPHARM/PREMIER Project Workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Prof Sharon Pfleger (PI) attended and presented at the PREMIER and TransPharm project workshops on 4-6 April in Nijmegen, the Netherlands. The workshops brought together a unique range of experts and professionals representing different stakeholders involved in the discovery, production, prescription, use and regulation of pharmaceuticals. Key questions to address included: What is a sustainable pharmaceutical product? Can sustainability considerations be included in the discovery/design process of new active pharmaceutical ingredients (APIs)? And what information needs does the health sector have when it comes to the sustainability of pharmaceuticals? Prof Pfleger presented "The Environmental Impact of Medicines, and How to Reduce It", which showcased ongoing work in Scotland to address the issue of pharmaceutical pollution in the environment and promoted the UKRI MRC project and objectives. The audience was engaged throughout, and questions were asked on the scope and planned activity for the framework development through environmental risk modelling. The main outcomes included increased awareness on the tools/resources needed to develop more sustainable healthcare practices, and the impact which healthcare and environmental sectors can achieve when working together. Prof Pfleger's participation at this event has strengthened engagement with European researchers, industry professionals, and healthcare professionals from the PREMIER and Transpharma projects (international projects, supported by the Innovative Medicines Initiative partnership between the EU and European pharmaceutical industry). |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://imi-premier.eu/premier-transpharm-workshop-on-sustainable-pharmaceuticals/ |
| Description | Twitter conference |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | The Twitter/X conference, organised by the One Health Breakthrough Partnership and hosted on September 26 2023 was dedicated to raising awareness of the issue of pharmaceuticals in the environment. The event sought to showcase ongoing research in this field in Scotland, and drive forward impactful solutions and foster collaboration to mitigate the environmental impacts of pharmaceutical pollution within Scotland and beyond. Twitter/X provided a platform to reach wider and more varied audiences than would normally be reached through a scientific conference, and to create social media content which would be publicly accessible after the event finished. The event explored the environmental impact of pharmaceuticals, emphasising the significance within the One Health framework, and highlighted innovative research and initiatives in sustainable healthcare, including how these advancements could be integrated into healthcare practices to minimise the environmental impact of pharmaceuticals. The event included 1 keynote (Baroness Natalie Bennett, Green Party peer) and 13 presentations, with the research team delivering a presentation on the MRC research project and its outcomes. The social reach totalled at 808,300 unique users reached and 5.4 million impressions (the number of times a tweet was viewed). The social engagement included 1,100 unique interactions, 752 likes, 305 reposts, with 480 mentions of the event hashtag (#OHBP2023). The event sparked discussion between participants and public on issues including pharmaceutical pollution and sustainable healthcare, such as how to include environmental scientists in healthcare decision making, and the ethical considerations of more sustainable healthcare. Requests were made for further information about the MRC project. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://ohbp.org/2023/10/20/ohbp-twitter-x-conference-2/ |
| Description | Workshop - NHS Scotland Climate Emergency and Sustainability Programme - Sustainable Care workstream event |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The PI (Prof Sharon Pfleger) co-led a workshop "Pharmaceuticals in the environment and Sustainable prescribing" at the NHS Scotland Climate Emergency and Sustainability Programme - Sustainable Care workstream event, with the Scottish Government Climate Change and Sustainability Board. The workshop (45 min) ran twice, and aimed to educate participants on the issue of pharmaceutical pollution in the water environment and sustainable prescribing methods to reduce environmental pollution from medicines, and to obtain their views on this topic. It included introductory presentations on the issue of pharmaceutical pollution and the outputs from the MRC funded research project "Developing frameworks towards eco-directed sustainable prescribing". Participants carried our interactive breakouts to assess attitudes and voice suggestions towards adopting sustainable prescribing in practice. The audience was engaged throughout the workshops, and many questions were asked about the issue of pharmaceutical pollution, pros/cons of sustainable prescribing, and recommendations put forward. The PI networked with clinicians and researchers with similar interests, and this has developed into a new collaboration. Sustainable prescribing has been recognised as a priority pillar of the sustainable healthcare policy in Scotland. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://book.shsc.scot/shsc/frontend/reg/tOtherPage.csp?pageID=203469&eventID=554&traceRedir=2 |