Sustainable Pharmacy Practice:A Qualitative Exploration of Pharmacist Prescribing Practices in Respiratory Disease Management

Background: Sustainable pharmacy practice integrates environmental, economic, and social dimensions to optimise healthcare delivery and long-term viability whilst minimising the environmental impact of prescribing. Increasingly, pharmacists’ pivotal role in pharmaceutical care in respiratory disease in general practice may contribute to sustainable pharmacy practice.<br/><br/>Aim: This study aimed to explore the prescribing practices of pharmacists working in a general practice setting in England to manage respiratory diseases, focusing on sustainable practices, using the Theoretical Domains Framework (TDF).<br/><br/>Method: A qualitative study was conducted using semi-structured interviews with independent prescribing pharmacists working in general practice settings in England involved in respiratory disease management. Independent prescribing pharmacists working in a general practice setting were eligible for this study. The interviews explored pharmacists’ experiences, decision-making processes, and the perceived impact of their practices on sustainability. Data were analysed thematically using the Theoretical Domains Framework (TDF) to identify key themes and influencing factors. Ethical approval was obtained from the University of Huddersfield.<br/><br/>Results: Eleven pharmacists (five male and six female) participated in interviews. Interviews typically lasted approximately 20 min. The prominent TDF behavioural domains that were found to influence the choice of inhaler therapies prescribed for patients with respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD) were knowledge and skills; training; and intentions and motivations. Participants reported a balance between patient choice and preference of inhaler therapy, concordance with prescribed therapies and national prescribing indicators as key considerations influencing prescribing behaviours. Knowledge regarding a structured approach to manage inhaler prescribing to align with national prescribing indicator targets was inconsistent.<br/><br/>Conclusion: This study provides valuable insights into the sustainable prescribing practices of pharmacists in respiratory disease management in a general practice setting. Findings highlight the significance of knowledge, training, intentions, and motivations in influencing prescribing practices. The identified key behavioural determinants can be mapped to evidence-based behavioural change strategies to develop a more structured approach to interventional development to environmental sustainability in respiratory disease management in a general practice setting in the UK.