Greener Asthma Prescribing: A qualitative study exploring primary healthcare professional perspectives on reducing prescribing of metered dose inhalers for asthma

Franklin, Lauren Hope Kathleen

Abstract

Background: In 2020, the NHS developed its carbon net zero goals and highlighted metered dose inhalers (MDIs) as a focal point for change. MDIs are commonly prescribed for asthma in primary care and contain potent greenhouse gases, accounting for 3% of the NHS’ carbon footprint. Despite targets to reduce MDI prescribing and increase use of dry powdered inhalers (DPIs), there is little evidence to support active implementation of this guidance and realisation of these targets. This study aims to explore healthcare professionals’ perspectives on reducing the prescribing of MDIs for people with asthma.

Methods: Semi-structured interviews with general practitioners, practice nurses and clinical pharmacists were performed, using topic guides that were iteratively developed using a constantcomparison approach. Participants were recruited through supervisor networks alongside snowball and purposeful sampling. Data were analysed using thematic analysis. A patient and public involvement and engagement group (PPIE) were involved in this study at the research design phase.

Results: 18 healthcare professionals were interviewed: 8 general practitioners, 6 practice nurses and 4 clinical pharmacists. The findings are divided into two sections. The first section focuses on factors that influence decision-making when choosing which inhaler to prescribe for asthma and includes the themes: Patient-centred care; Making assumptions; Status quo; and Clinician confidence and knowledge. The second section discusses barriers and facilitators to reducing the proportion of MDIs prescribed and includes the themes: Awareness; Attitudes towards change; Engagement with sustainable prescribing; the role of incentives; and Guidelines and systems.

Conclusions: Prescriber, consultation and external factors influence inhaler device decision-making in primary care. Clinicians lack knowledge of key elements of asthma management, importantly inhaler technique. Organisational culture impacts decision-making and must be adapted to accommodate low-carbon asthma care. Education will play a vital role in improving the quality of asthma management in primary care and reducing carbon emissions associated with inhaler prescribing.

Citation

Franklin, L. H. K. (2024). Greener Asthma Prescribing: A qualitative study exploring primary healthcare professional perspectives on reducing prescribing of metered dose inhalers for asthma. (Thesis). Keele University. Retrieved from https://keele-repository.worktribe.com/output/775420

• Thesis Type: Thesis
• Deposit Date: Mar 14, 2024
• Publicly Available Date: Mar 14, 2024
• Public URL: https://keele-repository.worktribe.com/output/775420
• Award Date: 2024-03