TY - JOUR
T1 - Advancing sustainable medication use in healthcare
T2 - a Delphi study on (de)prescribing interventions
AU - Smale, Elisabeth Marissa
AU - van der Giessen, Jiske Lianne
AU - Appels, Cathelijne Willemijne Yvonne
AU - Leegwater, Emiel
AU - Dietz, Marlieke
AU - van den Bemt, Patricia Maria Lucia Adriana
AU - Coenradie, Saskia
AU - Kool, Rudolf Bertijn
AU - Kwint, Henk-Frans
AU - Ista, Erwin
AU - Hunfeld, Nicole
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
PY - 2026/5/7
Y1 - 2026/5/7
N2 - OBJECTIVE: To identify and prioritise the most appropriate (de)prescribing interventions in inpatient and outpatient hospital care to advance environmentally sustainable healthcare.DESIGN: A modified RAND Delphi study.SETTING: Inpatient and outpatient hospital care in the Netherlands.PARTICIPANTS: The Delphi panel consisted of 63 participants, comprising 36 physicians and 27 pharmacists working in Dutch hospitals.PRIMARY AND SECONDARY OUTCOME MEASURES: Consensus on the appropriateness of (de)prescribing interventions for frequently used medications in inpatient and outpatient hospital care to advance environmentally sustainable healthcare and the prioritisation of interventions per care setting (inpatient/outpatient) and intervention type (deprescribing/sustainable dosage form), culminating in a top 20.RESULTS: 51 (de)prescribing interventions were identified for 18 medication classes, for which consensus on appropriateness was reached for 42 (82%). The top 20 highest ranked interventions were identified, starting with switching from intravenous to oral administration of paracetamol, stopping chronically used proton pump inhibitors without indication and initiating antibiotics orally in case of good bioavailability.CONCLUSIONS: Most (de)prescribing interventions were considered appropriate for advancing sustainable medication use, highlighting support for their potential implementation to reduce the environmental burden of healthcare.
AB - OBJECTIVE: To identify and prioritise the most appropriate (de)prescribing interventions in inpatient and outpatient hospital care to advance environmentally sustainable healthcare.DESIGN: A modified RAND Delphi study.SETTING: Inpatient and outpatient hospital care in the Netherlands.PARTICIPANTS: The Delphi panel consisted of 63 participants, comprising 36 physicians and 27 pharmacists working in Dutch hospitals.PRIMARY AND SECONDARY OUTCOME MEASURES: Consensus on the appropriateness of (de)prescribing interventions for frequently used medications in inpatient and outpatient hospital care to advance environmentally sustainable healthcare and the prioritisation of interventions per care setting (inpatient/outpatient) and intervention type (deprescribing/sustainable dosage form), culminating in a top 20.RESULTS: 51 (de)prescribing interventions were identified for 18 medication classes, for which consensus on appropriateness was reached for 42 (82%). The top 20 highest ranked interventions were identified, starting with switching from intravenous to oral administration of paracetamol, stopping chronically used proton pump inhibitors without indication and initiating antibiotics orally in case of good bioavailability.CONCLUSIONS: Most (de)prescribing interventions were considered appropriate for advancing sustainable medication use, highlighting support for their potential implementation to reduce the environmental burden of healthcare.
KW - Consensus
KW - Delphi Technique
KW - Deprescriptions
KW - Drug Prescriptions
KW - Female
KW - Humans
KW - Inappropriate Prescribing/prevention & control
KW - Male
KW - Netherlands
KW - Practice Patterns, Physicians'
U2 - 10.1136/bmjopen-2025-115383
DO - 10.1136/bmjopen-2025-115383
M3 - Article
C2 - 42097649
SN - 2044-6055
VL - 16
JO - BMJ Open
JF - BMJ Open
IS - 5
M1 - e115383
ER -