Donaldson Meredith, Deaney Carl
Marsh Medical Practice, Louth, Lincolnshire, UK.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251334217. doi: 10.1177/21501319251334217. Epub 2025 Apr 21.
Asthma and COPD are among the most prevalent chronic respiratory conditions, with inhalers as their primary pharmacological treatment. In the UK, metered-dose inhalers (MDIs) account for 70% of all inhaler prescriptions and contribute significantly to the NHS's carbon footprint, making green prescribing a critical focus. Aligning environmental sustainability with clinical excellence is essential to reducing exacerbations and deaths while minimising carbon emissions.
This initiative aimed to assess the localised impact of a structured quality improvement program designed to enhance respiratory care and integrate sustainable prescribing practices. Specifically, it sought to evaluate prescribing patterns, respiratory review completion rates, and the feasibility of transitioning patients from MDIs to lower-carbon alternatives whilst maintaining clinical outcomes.
The initiative, implemented at a UK general practice in January 2020, focussed on staff education, restructuring respiratory consultations, and patient engagement. The "treatable traits" paradigm and best practice frameworks guided the program to optimise individualised care. Prescribing data, in-date respiratory review rates, and estimated carbon emissions were analysed over 4 years (2020-2024) using publicly available sources such as OpenPrescribing.net. While education was a component of the intervention, no formal assessment was conducted on its direct impact on prescribing behaviours.
The practice achieved an in-date respiratory review rate exceeding 90%, rising to over 96% during the most recent QOF period. Over 4 years, the proportion of non-salbutamol MDI prescriptions decreased from 62.9% to 36.2%, aligning with national sustainability goals. Despite growth in the practice population, overall carbon emissions from inhalers were successfully reduced, reflecting a shift towards lower-carbon prescribing.
This initiative illustrates the feasibility of integrating sustainable prescribing practices into routine respiratory care, aligning with the goals of the national health system. This work highlights the potential of local-level interventions to contribute to broader sustainability efforts in respiratory medicine. Improvements in prescribing patterns and review rates have been noted, but more research is needed to evaluate the impact of educational interventions on healthcare providers' and patients' decisions. Future initiatives should focus on structured evaluations of long-term adherence and clinical outcomes.
哮喘和慢性阻塞性肺疾病（COPD）是最常见的慢性呼吸道疾病，吸入器是其主要药物治疗手段。在英国，定量吸入器（MDIs）占所有吸入器处方的70%，对英国国家医疗服务体系（NHS）的碳足迹有显著影响，因此绿色处方成为关键关注点。将环境可持续性与卓越临床相结合对于减少病情加重和死亡，同时将碳排放降至最低至关重要。
该倡议旨在评估一项结构化质量改进计划的局部影响，该计划旨在加强呼吸护理并整合可持续的处方实践。具体而言，它试图评估处方模式、呼吸复查完成率，以及在维持临床效果的同时，将患者从定量吸入器转换为低碳替代品的可行性。
该倡议于2020年1月在英国一家全科诊所实施，重点是员工教育、重组呼吸咨询和患者参与。“可治疗特征”范式和最佳实践框架指导该计划以优化个性化护理。使用OpenPrescribing.net等公开可用来源，对4年（2020 - 2024年）期间的处方数据、及时呼吸复查率和估计碳排放量进行了分析。虽然教育是干预措施的一个组成部分，但未对其对处方行为的直接影响进行正式评估。
该诊所实现了及时呼吸复查率超过90%，在最近的质量与结果框架（QOF）期间升至96%以上。在4年时间里，非沙丁胺醇定量吸入器处方的比例从62.9%降至36.2%，符合国家可持续发展目标。尽管诊所患者数量有所增加，但吸入器的总体碳排放量成功减少，这反映了向低碳处方的转变。
该倡议表明将可持续处方实践纳入常规呼吸护理是可行的，符合国家卫生系统的目标。这项工作凸显了地方层面干预措施对呼吸医学更广泛可持续发展努力做出贡献的潜力。已注意到处方模式和复查率有所改善，但需要更多研究来评估教育干预对医疗服务提供者和患者决策的影响。未来的倡议需要对长期依从性和临床结果进行结构化评估。
