Perception of Physicians Towards Eco-directed Sustainable Prescribing from the Perspective of Ecopharmacovigilance

Introduction: Eco-directed sustainable prescribing (EDSP) is an effective upstream way to reduce the environmental footprints of active pharmaceutical ingredients (APIs), a kind of emerging contaminants, from the patients’ excretion. EDSP is one of the key steps in the programme of ecopharmacovigilance (EPV), a drug administration route for API pollution. Objective: To assess the attitude of physicians prescribing medicines regarding EDSP from the perspective of EPV. Design: Descriptive and cross-sectional study. Study Population: Doctors from a tertiary care teaching hospital and private physicians. Study Period: January 2023-June 2023. Sample Size: 300. Outcome Measures: A questionnaire (reference: doi: 10.1136/bmjopen-2019–035502 ), which inquired about the participant characteristics, perceptions and attitudes toward API pollution, EPV and EDSP from an EPV perspective, a brief description of the terminologies such as EDSP, API and EPV, along with the questionnaire, was emailed to the physicians/ doctors. Results: Most physicians agreed on the existence of APIs in the environment, worried about the potential environmental and ecological risks of API residues, supported the effectiveness and necessity of EDSP under an EPV perspective in decreasing environmental exposure of excreted APIs and showed their willingness to participate in the EDSP practices. The most important barrier to the effective implementation of EDSP was identified as ‘poor awareness of EDSP and EPV’. Most responding physicians (63%) reported that they held the wait-and-see or conservative attitudes towards EDSP practice. The biggest concerns in low-dose prescribing were the possible negative impact on therapeutic outcomes and a long time will be taken to popularise it in clinical practice and prescribing of drugs possessing environment-friendly excretion profiles was too complicated and professional for the drug evaluation process. Conclusions: Physicians had positive attitudes towards EDSP from the perspective of EPV. However, their environmental consciousness during prescribing and the related education were insufficient.