Chinese physicians’ attitudes toward eco-directed sustainable prescribing from the perspective of ecopharmacovigilance: a cross-sectional study

Abstract

IntroductionEco-directed sustainable prescribing (EDSP) is an effective upstream way to reduce the environmental footprints of active pharmaceutical ingredients (APIs), a kind of emerging contaminants, from the patients’ excretion. EDSP is one of the key steps in the programme of ecopharmacovigilance (EPV), a drug administration route on API pollution.ObjectiveTo assess the attitudes of physicians prescribing medicines regarding EDSP from the perspective of EPV.DesignA cross-sectional study conducted from March 2019 to June 2019.Setting5 government general hospitals in Hubei province, China.Participants405 physicians were randomly selected and 262 valid questionnaires were obtained.Outcome measuresA self-developed questionnaire, which inquired about the participant characteristics, perceptions and attitudes toward API pollution, EPV and EDSP from an EPV perspective, was emailed to collect data from physicians.ResultsMost physicians agreed the existence of APIs in environment, worried about the potential environmental and ecological risks of API residues, supported the effectiveness and necessity of EDSP under an EPV perspective in decreasing environmental exposure of excreted APIs, and showed their willingness to participate in the EDSP practices. Nevertheless, no respondent identified the environmental impacts as the aspects regarding medicines affecting his(her) prescription decision, none was satisfied with knowledge on EDSP and showed confidence toward EDSP. The most important barrier to the effective implementation of EDSP was identified as ‘poor awareness of EDSP and EPV‘. Most responding physicians (97%) reported that they held the wait-and-see or conservative attitudes towards EDSP practice. The biggest concerns in low-dose prescribing and prescribing of drugs possessing environment-friendly excretion profiles, two EDSP approaches, were the possible negative impact on therapeutic outcomes and too complicated and professional drug evaluation process, respectively.ConclusionsChinese physicians had positive attitudes towards EDSP from the perspective of EPV. However, their environmental consciousness during prescribing and the related education were insufficient.

Impact of the COVID-19 pandemic on household disinfectant consumption behaviors and related environmental concerns: A questionnaire-based survey in China

“…So far, the well-accepted practice approaches to EPV include: promoting rational use of drugs, in particular, implementing eco-directed sustainable drug prescribing and dispensing practices to reduce the environmental footprints of PECs from the patients' excretion; improving pharmacy take-back programs and safe management strategies for expired and unused medicines; well-controlling the emissions from pharmaceutical manufacturing and hospitals; as well as accelerating the design and process development of green drugs, etc. Wang et al, ($year$) [11] , [12] , [26] , [27] , [28] …”

Broadening the Perspective on Reducing Pharmaceutical Residues in the Environment

“…It holds particular promise for addressing specific problematic compounds and can be used in tandem with “green chemistry.” However, EDSP requires integrating data on environmental profiles of pharmaceuticals—possibly with consideration of a wider range of environmental impacts than ecotoxicological risk alone—in rational prescribing guidelines and medicine formularies that consider environmental effects of pharmaceuticals. Moreover, because EDSP promotes changes in prescribing practices, its implementation requires addressing the behavioral and systemic challenges of prescribers (e.g., physicians, pharmacists) in implementing “new” and “environmentally informed” clinical guidelines (Wang et al., 2020).…”

Ecopharmacovigilance: A review of cause, impact, and remedies

“…Education and training in ecopharmacovigilance and environmentally conscious prescribing are essential components identified by some researchers that could significantly impact how medicines are used and disposed of. 29 Taking cues from operational history of pharmacovigilance programmes, successful strategies such as spontaneous reporting, intensive monitoring and database studies, have been proposed as starting points for eco pharma covigilance. 30 These activities can be implemented for continued environmental risk assessment of products approved by the pharmaceutical regulator.…”