Currently submitted to: Journal of Medical Internet Research
Date Submitted: Oct 6, 2026
Open Peer Review Period: Oct 7, 2026 - Dec 2, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Interventions to Support Eco-Directed Sustainable Prescribing of Medicines: Scoping Review
ABSTRACT
Background:
Medicines contribute substantially to healthcare-related greenhouse gas emissions, yet it is unclear what interventions have been developed and/or implemented to support prescribers with the selection of medicines with a lower environmental impact.
Objective:
This scoping review mapped interventions used or recommended to support eco-directed sustainable prescribing of medicines.
Methods:
The Joanna Briggs Institute (JBI) methodology was used, and the review reported according to PRISMA-ScR. Eight large databases were searched, including MEDLINE, Embase, PsycINFO, Scopus, Web of Science, CINAHL, IEEE Xplore, and GreenFILE. Search terms relating to ‘environmental sustainability’, ‘prescribing’ and ‘medicines’ were used. Eligible evidence was charted and synthesised descriptively, with primary research studies critically appraised to contextualise findings.
Results:
Five primary research studies and three policy/guidance documents were included. All primary studies were conducted in high-income hospital settings and focused on respiratory care or anaesthesia. Three approaches were identified: standalone education, education with digital support, and education with hospital-wide interventions. All five studies reported reductions in the targeted high-carbon medicine or prescribing practice, with some also reporting lower CO₂e emissions and costs. Key components that helped EDSP included brief face-to-face education, optimisation of fresh-gas flow, reduced desflurane availability and regular feedback. Policy documents extended these approaches through recommendations on prescribing guidance, formularies, procurement and governance.
Conclusions:
Primary research studies were found to concentrate on a small number of therapeutic areas. Future research should explore wider clinical contexts and examine how environmental information can be co-designed with prescribers and embedded into electronic prescribing and decision-support systems without compromising clinical judgement, patient choice or workflow. Clinical Trial: N/a
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