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Open Access 01-12-2023 | Research

Knowledge support for environmental information on pharmaceuticals: experiences among Swedish Drug and Therapeutics Committees

Authors: Elkanah Linder, Björn Wettermark, Marie-Louise Ovesjö, Sofia Kälvemark Sporrong, Helena Ramström

Published in: BMC Health Services Research | Issue 1/2023

Abstract

Background

Two publicly available Swedish knowledge support systems, “Pharmaceuticals and Environment” on Janusinfo.se and Fass.se, provide environmental information on pharmaceuticals. Janusinfo is provided by the public healthcare system in Stockholm and Fass is provided by the pharmaceutical industry. The objectives of this study were to investigate the experiences among Swedish Drug and Therapeutics Committees (DTCs) with using the databases, retrieve development proposals for these, and investigate the DTCs’ challenges with working with pharmaceuticals in the environment.

Methods

A cross-sectional survey with 21 questions, both closed and open-ended, was distributed electronically in March 2022 to Sweden’s 21 DTCs. Descriptive statistics and inductive categorization were used for the analysis.

Results

A total of 132 respondents from 18 regions filled out the survey. The average regional response rate was 42%. The DTCs used the knowledge supports to consider environmental aspects of pharmaceuticals in their formularies and in education. Respondents were more familiar with Janusinfo compared to Fass but appreciated the availability of both. The DTCs especially valued the concrete proposals for certain active pharmaceutical ingredients on Janusinfo. Respondents requested that all medicinal products have environmental information on Fass. Challenges included lack of data, lack of transparency from the pharmaceutical industry and difficulties considering the environmental aspect of pharmaceuticals in their healthcare practice. Respondents wanted more knowledge, clear messages, and legislation to support their work to reduce the negative environmental impact of pharmaceuticals.

Conclusions

This study demonstrates that knowledge supports for environmental information on pharmaceuticals are valuable for the DTCs in Sweden, but the respondents experienced challenges in their work in this field. The study can provide insights to those in other countries interested in considering environmental aspects in their formulary decision-making.

Available only for authorised users

Sweden is divided into 21 regions: the three biggest (Skåne, Västra Götaland and Stockholm) have between 1.4 and 2.4 million inhabitants each. The smallest region (Gotland) has around 61,000 inhabitants and the other 17 regions have a population between 130,000 and 470,000 inhabitants [12].

Sedvall E, Fick J, Pettersson C, et al. Pharmaceuticals are identified in insects in River Fyris – A study with both tandem quadrupole and quadrupole-time-of-flight mass spectrometry. Environ Adv. 2022. https://doi.org/10.1016/j.envadv.2022.100194.CrossRef

Larsson DGJ, de Pedro C, Paxeus N. Effluent from drug manufactures contains extremely high levels of pharmaceuticals. J Hazard Mater. 2007. https://doi.org/10.1016/j.jhazmat.2007.07.008.CrossRefPubMed

Anliker S, Loos M, Comte R, et al. Assessing emissions from pharmaceutical manufacturing based on temporal high-resolution mass spectrometry data. Environ Sci Technol. 2020. https://doi.org/10.1021/acs.est.9b07085.CrossRefPubMed

aus der Beek T, Weber FA, Bergmann A, et al. Pharmaceuticals in the environment–global occurrences and perspectives. Environ Toxicol Chem. 2016. https://doi.org/10.1002/etc.3339.CrossRefPubMed

Wilkinson JL, Boxall ABA, Kolpin DW, et al. Pharmaceutical pollution of the world’s rivers. Proc Natl Acad Sci U S A. 2022. https://www.pnas.org/doi/10.1073/pnas.2113947119CrossRefPubMedPubMedCentral

European Commission. Chemicals strategy for sustainability: Towards a toxic-free environment. In: Chemicals policy. Circabc. 2022. https://circabc.europa.eu/ui/group/8ee3c69a-bccb-4f22-89ca-277e35de7c63/library/dd074f3d-0cc9-4df2-b056-dabcacfc99b6/details?download=true. Accessed 11 May 2023.

European Commission. Proposal for a Directive of the European parliament and of the council amending Directive 2000/60/EC establishing a framework for Community action in the field of water policy, Directive 2006/118/EC on the protection of groundwater against pollution and deterioration and Directive 2008/105/EC on environmental quality standards in the field of water policy. In: Environment. European Commission. 2022. https://environment.ec.europa.eu/system/files/2022-10/Proposal%20for%20a%20Directive%20amending%20the%20Water%20Framework%20Directive%2C%20the%20Groundwater%20Directive%20and%20the%20Environmental%20Quality%20Standards%20Directive.pdf. Accessed 05 May 2023.

Sjöqvist F, Bergman U, Dahl M-L, et al. Drug and therapeutics committees: a swedish experience. WHO Drug Inf. 2002;16:207–13.

Sofat R, Cremers S, Ferner RE. Drug and therapeutics committees as guardians of safe and rational medicines use. Br J Clin Pharmacol. 2020. https://doi.org/10.1111/bcp.14088.CrossRefPubMed

10.

Holloway K, Green T, editors. Drug and therapeutics committees: A practical guide. In: Institutional Repository for Information Sharing. World Health Organization. 2003. https://apps.who.int/iris/bitstream/handle/10665/68553/WHO_EDM_PAR_2004.1.pdf?sequence=1&isAllowed=y. Accessed 08 May 2023.

11.

Hoffmann M. The right drug, but from whose perspective? A framework for analysing the structure and activities of drug and therapeutics committees. Eur J Clin Pharmacol. 2013;69(Suppl 1):79–87.CrossRefPubMedPubMedCentral

12.

Statistics Sweden. Population in the country, counties and municipalities on March 31, 2022, and population change in January–March 2022. In: Population statistics. 2022. https://www.scb.se/en/finding-statistics/statistics-by-subject-area/population/population-composition/population-statistics/. Accessed 23 June 2022.

13.

Sveriges Riksdag. [Lag. (1996:1157) om läkemedelskommittéer]. In: [Dokument & lagar]. 1996. https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/lag-19961157-om-lakemedelskommitteer_sfs-1996-1157. Accessed 28 June 2022.

14.

Godman B, Wettermark B, Hoffmann M, et al. Multifaceted national and regional drug reforms and initiatives in ambulatory care in Sweden: global relevance. Expert Rev Pharmacoecon Outcomes Res. 2009. https://doi.org/10.1586/14737167.9.1.65.CrossRefPubMed

15.

Ramström H, Martini S, Borgendahl J, et al. Pharmaceuticals and environment: a web-based decision support for considering environmental aspects of medicines in use. Eur J Clin Pharmacol. 2020. https://doi.org/10.1007/s00228-020-02885-1.CrossRefPubMedPubMedCentral

16.

Eriksen J, Gustafsson LL, Ateva K, et al. High adherence to the “Wise List” treatment recommendations in Stockholm: a 15-year retrospective review of a multifaceted approach promoting rational use of medicines. BMJ Open. 2017. https://doi.org/10.1136/bmjopen-2016-014345.CrossRefPubMedPubMedCentral

17.

Eriksen J, Ovesjö ML, Vallin M, et al. Primary care physicians report high trust in and usefulness of the Stockholm drug and therapeutic committee’s list of recommended essential medicines (the ’Wise List’). Eur J Clin Pharmacol. 2018. https://doi.org/10.1007/s00228-017-2354-8.CrossRefPubMed

18.

Gunnarsson B, Wennmalm Å. Mitigation of the pharmaceutical outlet into the environment – experiences from Sweden. In: Kümmerer K, editor. Pharmaceuticals in the environment: sources, fate, effects and risks. 3rd ed. Berlin Heidelberg: Springer-Verlag; 2008; 475–87.CrossRef

19.

Mattson B. A voluntary environmental classification system for pharmaceutical substances. Drug inf J. 2007. https://doi.org/10.1177/009286150704100209.CrossRef

20.

Ågerstrand M, Rudén C. Evaluation of the accuracy and consistency of the swedish environmental classification and information system for pharmaceuticals. Sci Total Environ. 2010. https://doi.org/10.1016/j.scitotenv.2010.02.020.CrossRefPubMed

21.

Felleskatalogen. [Legemidler og miljø]. In: Felleskatalogen. Felleskatalogen. https://www.felleskatalogen.no/medisin/miljo/legemiddel/a Accessed 05 May 2023.

22.

Pharmaca. Environmental classification of medicines available for the first time in Finland. In: Pharmaca. Pharmaca. 2022. https://pharmaca.fi/en/environmental-classification-of-medicines-available-for-the-first-time-in-finland/ Accessed 05 May 2023.

23.

Presser S, Couper MP, Lessler JT, et al. Methods for testing and evaluating survey questions. Public Opin Q. 2004. https://doi.org/10.1093/poq/nfh008.CrossRef

24.

Rattray J, Jones MC. Essential elements of questionnaire design and development. J Clin Nurs. 2007. https://doi.org/10.1111/j.1365-2702.2006.01573.x.CrossRefPubMed

25.

World Health Organization. Promoting rational use of medicines. In: World Health Organization. No date. https://www.who.int/activities/promoting-rational-use-of-medicines. Accessed 23 June 2022.

26.

Oelkers K. The accessibility of data on environmental risk assessment of pharmaceuticals – are environmental risk assessments information on emissions with respect to international and European environmental information law? Regul Toxicol Pharmacol. 2020. https://doi.org/10.1016/j.yrtph.2019.104571.CrossRefPubMed

27.

Årdal C, Baraldi E, Beyer P, et al. Supply chain transparency and the availability of essential medicines. Bull World Health Organ. 2021. https://doi.org/10.2471/BLT.20.267724.CrossRefPubMedPubMedCentral

28.

Medsafe. New Zealand Medicines and Medical Devices Safety Authority, Wellington. 2021. https://www.medsafe.govt.nz/regulatory/DBSearch.asp. Accessed 5 Oct 2022.

29.

MistraPharma. Identification and reduction of environmental risks caused by human pharmaceuticals. MistraPharma research 2008–2015. Final Report. In: MistraPharma. 2015; https://www.mistra.org/wp-content/uploads/2015/10/MistraPharma-FinalReport-2008-2015-ENG.pdf. Accessed 22 Aug 2022.

30.

Committee for Medicinal Products for Human Use (CHMP) EMA. Guideline on the environmental risk assessment of medicinal products for human use. Doc. Ref. EMEA/CHMP/SWP/4447/00 corr 2. In: European Medicines Agency. 2006. https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-environmental-risk-assessment-medicinal-products-human-use-first-version_en.pdf. Accessed 17 Oct 2022.

31.

Sumpter JP, Johnson AC, Runnalls TJ. Pharmaceuticals in the aquatic environment: no answers yet to the major questions. Environ Toxicol Chem. 2022. https://doi.org/10.1002/etc.5421.CrossRefPubMed

32.

Blair BD. Potential upstream strategies for the mitigation of pharmaceuticals in the aquatic environment: a brief review. Curr Envir Health Rpt. 2016. https://doi.org/10.1007/s40572-016-0088-x.CrossRef

33.

Cussans A, Harvey G, Kemple T, et al. Interventions to reduce the environmental impact of medicines: a UK perspective. J Clim Chang Health. 2021. https://doi.org/10.1016/j.joclim.2021.100079.CrossRef

34.

Swedish Medical Products Agency. [Läkemedelsbehandling vid inflammatorisk tarmsjukdom (IBD)]. In: The Swedish Medical Products Agency. 2021. https://www.lakemedelsverket.se/49b96a/globalassets/dokument/behandling-och-forskrivning/behandlingsrekommendationer/behandlingsrekommendation/behandlingsrekommendation-inflammatorisk-tarmsjukdom-ibd.pdf. Accessed 10 Oct 2022.

35.

Moermond CTA, de Rooy M. The dutch chain approach on pharmaceuticals in water: stakeholders acting together to reduce the environmental impact of pharmaceuticals. Br J Clin Pharmacol. 2022. https://doi.org/10.1111/bcp.15509.CrossRefPubMed

Title: Knowledge support for environmental information on pharmaceuticals: experiences among Swedish Drug and Therapeutics Committees
Authors: Elkanah Linder
Björn Wettermark
Marie-Louise Ovesjö
Sofia Kälvemark Sporrong
Helena Ramström
Publication date: 01-12-2023
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2023
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-023-09646-7

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Springer Medicine

Knowledge support for environmental information on pharmaceuticals: experiences among Swedish Drug and Therapeutics Committees

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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