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

Abstract

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. To explore primary healthcare professionals' perspectives on reducing the prescribing of pMDIs for people with asthma to reduce associated carbon emissions. Qualitative study of healthcare professionals (GPs, practice nurses [PNs], and clinical pharmacists [CPs]) working in general practice in England. 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. Eight GPs, six PNs, and four CPs were interviewed. Results are presented over two topics. The first explores factors influencing inhaler device choice and discusses the following 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 following themes: understanding; attitudes to change; confidence in dry powder inhalers (DPIs); attitudes to change; engagement with sustainable prescribing; and system drivers. Interlinking personal, consultation, and external factors influence which inhaler device is prescribed for patients with asthma. There are considerable actionable barriers to implementing carbon-conscious prescribing, many of which would improve the quality of asthma care.