# Perspectives of primary care healthcare professionals on interventions aimed at reducing the environmental impact of medicines: a mixed-methods systematic review protocol

## TL;DR

This study aims to understand how primary care healthcare professionals view interventions to reduce the environmental impact of medicines.

## Contribution

The novelty lies in systematically reviewing healthcare professionals' perspectives on environmental interventions in primary care.

## Key findings

- Pharmaceutical pollution affects human and animal health through excretion, disposal, and effluent discharge.
- Primary care is a key setting for reducing the environmental impact of medicines due to high prescribing rates.
- Healthcare professionals' views on interventions remain unclear and warrant systematic exploration.

## Abstract

Medicines can affect the environment throughout their lifecycle; from manufacturing to use and disposal. Medicines can enter the environment through various sources, some controllable and others not. Excretion is the primary source of pharmaceutical pollution; however, secondary sources also include improper disposal and effluent discharge. This pharmaceutical pollution can harm both human and animal health. As most prescribing occurs in primary care, it is a key setting for interventions aimed at reducing the environmental impact of medicines. The perceptions of healthcare professionals regarding these efforts remain unclear.

This systematic review aims to explore the perspectives of healthcare professionals working in primary care regarding interventions designed to reduce the environmental impact of medicines.

Systematic searches of MEDLINE, Embase, Web of Science, and CINAHL will be undertaken. Studies using qualitative, quantitative, or mixed-methods designs will be included if they explore the perspectives of primary care healthcare professionals on interventions to reduce the environmental impact of medicines. Title and abstract screening, followed by full-text review, will be performed independently and in duplicate. Study quality will be appraised independently by two reviewers using the appropriate Joanna Briggs Institute (JBI) critical appraisal tool. A data extraction tool will be developed, piloted, and applied to collect relevant information, with extraction conducted independently and in duplicate. Quantitative data will be qualitised and integrated with qualitative evidence as part of a convergent integrated synthesis, with findings presented in the form of a narrative synthesis.

This review will help inform the design and implementation of future environmental interventions in primary care. By understanding healthcare professionals’ perspectives on existing or proposed interventions, future strategies can be tailored to improve their acceptability and feasibility.

This protocol has been registered on PROSPERO (CRD420251247490). Any amendments to this protocol will be documented and uploaded as revision notes on all platforms where the protocol is published.