Climate conscious pharmacy practice: a qualitative interview study with pharmacists in the context of respiratory...

Climate change negatively impacts millions of people with respiratory conditions. On the other hand, respiratory health care negatively impacts climate change given that mainstay inhaler treatment poses its own environmental risk. Pharmacists are frequently involved in managing chronic respiratory conditions including counselling on inhaler use, thus they are well-positioned to reduce associated environmental impacts, however this role is unexplored.

This study aimed to investigate Australian pharmacists' perceptions on the impact of climate change on respiratory health and the impact of respiratory health care provision or treatment use on the environment. We also aimed to explore pharmacists' views about their potential roles in promoting sustainable respiratory health care.

Following approval from an institutional ethics review committee, qualitative semi-structured interviews were conducted with consenting pharmacists who had at least one year of post-registration experience and were currently working in any clinical setting. The interviews explored pharmacists' general perspectives on climate change before delving specifically into respiratory health care. Interviews were recorded, transcribed verbatim and subjected to an inductive thematic analysis within a constructivist paradigm.

Thirty-two participants (72% female, 28% male) were interviewed. Three key themes were derived from the analysis: (1) environment considerations as an afterthought, (2) linking environment to respiratory care, and (3) working towards sustainable practice. Patient health was expressed as the main concern in clinical practice, with environmental considerations reported as lower priority. Most participants saw their role as being the management of patients 'respiratory symptom control'. Barriers to climate action described by participants included prescriber and patient acceptance of recommendations and concerns about counselling patients on switching to low carbon footprint inhalers being beyond their current scope of practice. Participants recommended multi-stakeholder collaboration and inclusion of this topic in pharmacy curricula as key factors to address to build sustainable respiratory health care provision.

Pharmacists' main focus in respiratory health care provision is on clinical rather than environmental change issues. Many barriers such as concerns about patients' acceptance of sustainability related advice or counselling, and limited training on the topic were cited. Further research should explore best ways to address these issues, preferably in co-design practices with stakeholders.