title: A method to include the environmental hazard in drug prescribing.
abstract: OBJECTIVE
  Environmental classification systems for medicines have been proposed. It is important that these systems are integrated into clinical practice. Numerous studies have shown that feedback to healthcare professionals of their prescribing patterns is effective in changing behaviour. The aim of this study was to develop a method to incorporate an environmental classification for medicines in drug utilization data provided to prescribers. Drug prescribing was calculated on all pharmacy sales of medicines in ambulatory care in Stockholm, Sweden (1.9 million inhabitants) during 2006.
  
  
  METHODS
  Prescribing profiles were generated focusing on medicines that accounted for 90% of the volume (DU90%) of antibiotics (ATC-group J01), drugs for musculoskeletal conditions (NSAIDs, M01A), antihypertensive agents (C03, C07, C08 and C09) and antidepressants (N06A). The medicines in these 90% segments were measured as kilograms of active substance and were coded according to the classification of environmental hazard developed by Stockholm County Council and Apoteket AB. Main outcome measure Amount of pharmaceuticals dispensed (kg) and the classification of environmental hazard for the active substances accounting for the top 90% of the total amount prescribed.
  
  
  RESULTS
  A total of 16,800 kg of antibiotics, 23,400 kg of NSAIDs, 7,700 kg of various antihypertensive substances and 1,700 kg of antidepressants had been dispensed in the region, corresponding to 2.3, 3.3, 1.1 and 0.2 kg of drug substance per square kilometre, respectively. A total of 12, 3, 13 and 9 substances accounted for 90% of the total volume of antibiotics, NSAIDs, antihypertensives and antidepressants, respectively. The proportions of potentially high environmental hazard drugs were 0, 7, 0 and 24%, respectively.
  
  
  CONCLUSIONS
  The prescribing profiles gave an easily understandable overview for the potential environmental risk and indication for where improvement could be made. The 90% profiles were easy and inexpensive to produce using available sales data and may be a valuable tool to increase the awareness of the environmental aspects among prescribing doctors.
authors.affiliation: Research and Development, National Corporation of Swedish Pharmacies, Apoteket AB, 118 81, Stockholm, Sweden. staffan.castensson@apoteket.se
authors.forename: Staffan
authors.initials: S
authors.lastname: Castensson
authors.forename: Viktoria
authors.initials: V
authors.lastname: Eriksson
authors.forename: Kristina
authors.initials: K
authors.lastname: Lindborg
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
mesh_terms: D004363:Drug Utilization / Q000706:statistics & numerical data*; D015386:Hazardous Substances / Q000145:classification*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000145:classification* / Q000600:supply & distribution*; D014874:Water Pollutants, Chemical / Q000145:classification
chemical_list: D015386:Hazardous Substances; D055553:Prescription Drugs; D014874:Water Pollutants, Chemical