Developing frameworks for eco-directed sustainable prescribing: Towards reducing environmental pollution from healthcare practices

处方药物来诊断、治疗、治愈和预防疾病是医疗保健中最常见的干预措施——但是这种活动对环境产生了负面影响，药物污染现在是一个公认的全球公共卫生和环境问题。地表水中的抗生素、抗炎药、抗糖尿病药和抗抑郁药可对水生生物产生负面影响，导致女性化和生殖失败、生理和行为改变、免疫缺陷，并有助于抗菌素耐药性的传播（AMR -一个关键的公共卫生问题）。医疗保健可持续发展目标要求改进处方和药物选择，因为目前的做法在环境、经济、临床和社会上都是不可持续的。改进药物的选择、使用和处置可以减少医疗保健中的药物污染。该项目旨在英国首次开发和评估一个生态导向的处方框架，该框架将环境可持续性与临床和成本效益相结合。这表明，如果药物具有可比的医疗功效、安全性和有效性，那么在处方过程中应考虑环境影响（例如，药物生态毒性，对抗菌素耐药性的优势），以更好地告知处方者，使他们能够做出更可持续的处方选择。研究人员（代表NHS高地、诺丁汉大学和环境研究所-高地和岛屿大学）在医药公共卫生、处方开发、定性卫生服务研究、环境科学和跨部门合作方面有着良好的记录和专业知识。该项目将利用代表医疗保健、处方、环境和水部门主要利益相关者的国家和国际合作伙伴的既定网络和资源，包括苏格兰单一健康突破伙伴关系——一个全球独特的跨部门组织，它创建了一个交互式可视化工具，比较苏格兰（世界第一）的环境药物数据和处方率，以推进处方变化的优先顺序。调查人员将：询问环境和处方数据；评估环境危害指标的生态毒理学数据；通过有组织的共识和焦点小组活动确定标准的优先次序；通过新颖的应用建模技术开发一个健壮的决策公式框架；并且，与患者、医生和处方医生一起评估适用性。调查人员将与网络/利益攸关方团体合作，传播、教育和发展项目后活动，以便进行试点试验，以便付诸实施。该项目将满足这一呼吁的机遇和挑战，同时也：加强研究的可持续性和产生创新；整合新颖的研究方法；确保真正的个人价值指数和跨界别持份者参与；支持高级别传播和影响；并通过框架的下一阶段项目规划创造附加性，这可以在项目后进行试点，并在英国和国际层面上采用。该项目将是英国的创新之先，确定生态指导处方所需的新方法和数据，并导致对药物处方对环境影响的新理解和认识。它将为实践中的“阶梯式改变”创造机会，提高苏格兰药物处方和使用的质量，并通过提供更好的信息和更可持续的处方和药物选择，使NHS、从业者/处方者和患者受益。该项目将有助于减少药物对环境的污染，实现可持续性目标，解决生物多样性丧失和抗生素耐药性问题，并促进现在和未来的健康。

The prescription of a medicine to diagnose, treat, cure, and prevent disease is the most common intervention in healthcare - but this activity negatively impacts the environment, and pharmaceutical pollution is now a well-recognised global public health and environmental issue. Antibiotics, anti-inflammatories, antidiabetics, and antidepressants in surface water can negatively affect aquatic organisms, causing feminisation and reproductive failure, physiological and behavioural changes, immunodeficiency, and assistance in the spread of antimicrobial resistance (AMR - a critical public health issue). Healthcare sustainability targets call for improvements to prescribing and medicine selection, as current practices are environmentally, economically, clinically, and socially unsustainable. Improving medicine selection, use, and disposal can reduce pharmaceutical pollution from healthcare. This project seeks to develop and evaluate, for the first time in the UK, an eco-directed prescription framework that incorporates environmental sustainability alongside clinical and cost effectiveness. This proposes that if pharmaceuticals are of comparable medical efficacy, safety, and effectiveness, then the environmental impact (e.g., drug ecotoxicity, predominance towards AMR) should be considered during the formulary process to better inform prescribers, enabling them to make more sustainable prescribing choices. The research investigators (representing NHS Highland, University of Nottingham, and the Environmental Research Institute-University of the Highlands and Islands) have strong track-records and expertise in pharmaceutical public health, formulary development, qualitative health services research, environmental science, and cross-sector collaboration. The project will capitalise on the established networks and resources of national and international partners representing key stakeholders across the healthcare, prescribing, environment, and water sectors, including the Scottish One Health Breakthrough Partnership - a globally unique, cross-sector group which created an interactive visualisation tool comparing environmental pharmaceutical data and prescribing rates in Scotland (a world first) to progress prioritisation of formulary changes. Investigators will: interrogate environmental and prescribing data; evaluate ecotoxicological data for environmental hazard indicators; prioritise criteria through structured consensus and focus group activity; develop a robust decision-making formulary framework through novel application modelling techniques; and, engage with patients, practitioners, and prescribers to assess suitability. The investigators will work with networks/stakeholder groups to disseminate, educate, and develop post project activity for a pilot trial towards implementation. This project will meet the opportunities and challenges of this call, whilst also: enhancing research sustainability and generating innovation; integrating novel research methods; ensuring genuine PPI and cross-sector stakeholder engagement; supporting high-level dissemination and impact; and creating additionality through next-stage project planning of the framework, which can be piloted post-project and adopted at UK- and international-level.This project will be an innovation-first for the UK, identifying novel methods and data required for eco-directed prescribing and leading to new understanding and awareness of the environmental impact of pharmaceutical prescribing. It will create opportunities for a 'step change' in practice that improves the quality of medicine prescribing and use in Scotland, and benefits the NHS, practitioners/prescribers and patients through enabling better informed and more sustainable prescribing and medicine choices. The project will contribute to reduced environmental pollution from medicines, address sustainability targets, address biodiversity loss and AMR, and promote better health now and for the future.