OptimiseRx supports greener NHS initiatives with swapping inhalers in messages

With medicines accounting for up to 25% of NHS greenhouse emissions - and asthma inhalers making up 3% of those emissions – there was a real need to move away from the current way of prescribing. With recent evidence that shifting from metered-dose inhalers to lower carbon inhalers would deliver a reduction of 4% in emissions, the OptimiseRx team at FDB have worked on an important project to implement message switching to more environmentally friendly devices.  This supported FDB’s ICB customers in rolling out their workplans across PCNs and practices reflecting the 2021/ 2022 Impact and Investment Fund indicators (IIF).

We talk to Laura, who is a clinical pharmacist and leads the OptimiseRx content team about the work that went into making these changes. 

Hi Laura, can you tell us about what needs to be done to reduce emissions with asthma inhalers? 

Yes of course. Last year the IIF outlined the carbon footprint derived from inhalers. Inhalers are used to treat respiratory conditions, and - with around 60 million inhalers dispensed in England every year - emissions from inhalers make up around 3% of the NHS carbon footprint.  

In addition, Asthma+Lung UK (ALUK) recently published a study that showed that most of the patients asked would prefer to use more environmentally friendly options if appropriate. When they conducted a large survey of UK asthma patients, they found that ‘many people with asthma were unaware of the carbon footprint of their inhalers, but most would be willing to try a more environmentally friendly device.'¹  

There are other effective ways to treat asthma which have lower emissions - such as dry powder inhalers (DPIs). We at FDB immediately thought that this was something we could help with at the point of care with OptimiseRx. OptimiseRx delivers patient-specific prescribing information, integrated with prescribing workflows, and supports medicines optimisation at the point of care.

So, we set about creating a project that would support our customers and help GPs prescribing treatment for those with respiratory conditions to make informed decisions, which would in turn help in the move towards creating a greener NHS. 

Can you give me more background on OptimiseRx and the greener inhaler project and how the work started? 

We started by reviewing the Greener Practice Guide which list the inhalers with highest carbon footprint and provides guidance on swapping to inhalers with a lower carbon footprint. We have a large and experienced clinical content team at FDB who focus on OptimiseRx and the messages that we generate to ensure prescribers have the option to swap to an alternative product safely.

That sounds like a fairly simple swap for sophisticated software like OptimiseRx?

Well, yes and no! You need to have considerations for the patient and how this will affect them and in this case, you need to be mindful the patient is aware of the instructions for use and the breathing techniques for the different types of inhalers and their ability to use the new device. 

How did you and the content team go about it? 

We considered the licensing of the inhaler, the inhaler type, the strength equivalence, local formularies, cost, etc. Based on this we decided to target adult patients newly prescribed a specific inhaler to avoid inadvertently swapping someone that is already settled on a specific device and inhaler type.

The team reviewed the guidance and took it to a forum with senior clinicians where we discussed these messages to ensure all clinical aspects were considered. We then created national messages to advise prescribers to swap suitable patients to DPIs.

The intent for this project was environmental impact. Generally, we do cost-based swap equivalents, for example, if a product is cheaper to prescribe, and just as effective, we would recommend a message to swap to that medication. This has saved the NHS millions of pounds over the years. These, although they are more environmentally friendly swaps, could incur more expense to the NHS, but with NHS England pushing for net zero, this would be an incentive for prescribers.  

What details do prescribers have to consider? 

As this is not a straightforward swap, it’s really important that the messages we provide are specific and detailed.  The detail for the prescriber to ensure they have the right information for the patient is provided within the message, i.e. is my patient able to use new device? (as the breathing technique is different) Will I need to teach them how to use the device? And so on. 

Can you tell us the advantages you have seen of using these new messages?

Now the messages are available nationally, there has been an average acceptance rate of 23% on the most offered national message, although acceptance rates have been over 50% in some regions.  

We are aware that one customer, who used the new OptimiseRx messages within their strategy, has reduced CO2 emissions for their organisation by over 100 tonnes (of which DPIs were a part).²


How do OptimiseRx users become successful at implementing these new messages? 

Where there have been really good acceptance rates, there’s usually been a range of local education sessions targeting different groups of colleagues. There may also have been training sessions for PCN and Prescribing Support pharmacists. 

There were also cases of customising messages in portals, adding local text and URLs and amending alternatives.  Users also use OptimiseRx dashboards to identify practices doing well or those with more opportunities and link OptimiseRx with related local initiatives/campaigns.

This sounds like a really positive campaign with excellent results!

Yes, we are really pleased with the results and the work we put in to help support the NHS in its quest for more environmentally friendly prescribing.

¹ The sustainability agenda and inhaled therapy: what do patients want?

² The NHS in Sheffield helps reduce carbon emissions by swapping inhalers