Table 3.
Assessment of Chinese physicians’ perceptions and attitudes toward EDSP (n=262)
| Survey question/statement | Response | Respondents no. (%) |
| Q1: At present, the aspects regarding medicines affecting my prescription decision include:* | Efficacy | 262 (100) |
| Safety | 258 (98) | |
| Cost and economy | 246 (94) | |
| Convenience | 188 (72) | |
| Pharmacokinetics | 57 (22) | |
| Marketing and promoting | 139 (53) | |
| Environmental impacts | 0 (0) | |
| Q2: As prescribers, physicians bear a responsibility for reducing API releases to environment. | Strongly agree | 86 (33) |
| Agree | 83 (32) | |
| Undecided | 81 (31) | |
| Disagree | 12 (5) | |
| Strongly disagree | 0 (0) | |
| Q3: Previous to this survey, I have heard of EDSP. | Yes | 260 (99) |
| No | 2 (1) | |
| Q4: According to the description on the basic concept of EDSP provided on the first page of this questionnaire, I think EDSP is an effective tool to control the entrance of APIs into the environment. | Strongly agree | 54 (21) |
| Agree | 96 (37) | |
| Undecided | 101 (39) | |
| Disagree | 9 (3) | |
| Strongly disagree | 2 (1) | |
| Q5: I think the benefits of low-dose prescribing include:* | Reducing the environmental loading of API residues from patients’ excretions. | 257 (98) |
| Eliminating the subsequent need and cost for disposal of pharmaceutical leftovers | 240 (92) | |
| Reducing healthcare expenditures for patients. | 104 (40) | |
| Improving therapeutic efficacy via minimising off-target side-effects related to dosage, and thus enhancing pharmaceutical compliance. | 75 (29) | |
| Protecting public health by unintended poisonings by drugs (especially infants, toddlers and children) resulted from inappropriate storage or disposal. | 238 (91) | |
| Reducing drug diversion and the profound problems with attendant abuse of certain drugs and misuse of others. | 215 (82) | |
| Improving public trust—by reducing hidden and unwelcomed exposure of humans to trace levels of numerous APIs via potable water and contaminated foods. | 242 (92) | |
| Improving patient/physician communication. | 89 (34) | |
| Q6: My concerns regarding the low-dose prescribing are:* | It can not achieve ideal therapeutic efficacy, and might delay treatment. | 262 (100) |
| The lowest effective dose with environmental safety is not certain and available. | 259 (99) | |
| It is a new prescribing concept, therefore, a long time will be taken to popularise it in clinical practice. | 207 (79) | |
| It will change my prescribing habits, thus is too troublesome. | 55 (21) | |
| Q7: It is necessary to emphasise on the metabolism and excretion of drugs rather than the initially ingested dose by the patient, because the emission of APIs into the environment via sewers is dictated by the excretion profile and pharmacokinetics of the different types of pharmaceutical compounds. | Strongly agree | 79 (30) |
| Agree | 123 (45) | |
| Undecided | 48 (18) | |
| Disagree | 11 (4) | |
| Strongly disagree | 1 (0) | |
| Q8: My concerns regarding the prescribing of drugs possessing environment-friendly excretion profiles are:* | It can not achieve ideal therapeutic efficacy, and might delay treatment. | 35 (13) |
| Under the EDSP design, drug evaluation based on the excretion profile and pharmacokinetics is too complicated and professional. | 219 (84) | |
| There is no available accurate data on the excretion profile and pharmacokinetics of drugs. | 190 (73) | |
| It is a new prescribing concept, therefore, a long time will be taken to popularise it in clinical practice. | 211 (81) | |
| It will change my prescribing habits, thus is too troublesome. | 62 (24) | |
| Q9: My self-satisfaction with knowledge on EDSP. | Agree | 0 (0) |
| Disagree | 262 (100) | |
| Q10: My confidence toward EDSP. | Agree | 0 (0) |
| Disagree | 262 (100) | |
| Q11: For now, the EDSP behaviour that I want to choose first is: | None. I will take a wait-and-see approach. | 134 (51) |
| I will promote rational prescribing at precise doses, avoid overprescribing and misprescribing. | 121 (46) | |
| I will implement the low-dose prescribing. | 3 (1) | |
| I will prescribe drugs possessing environment-friendly excretion profiles as much as possible. | 4 (2) | |
| Q12: I think the most major perceived barrier to the effective implementation of EDSP under the perspective of EPV in China is: | Poor awareness of EDSP and EPV. | 101 (39) |
| Lack of an administrative framework for EDSP under the perspective of EPV. | 50 (19) | |
| Lack of available data related to EDSP under the perspective of EPV. | 96 (37) | |
| It conflicts with long-accepted prescribing guidelines. | 15 (6) | |
| Q13: I am very pleased to participate in EDSP activities in my future practice if it is successfully translated into clinical treatment. | Strongly agree | 85 (32) |
| Agree | 121 (46) | |
| Undecided | 53 (20) | |
| Disagree | 3 (1) | |
| Strongly disagree | 0 (0) |
*Multiple responses were permitted, percentages do not add to 100%.
APIs, active pharmaceutical ingredients; EDSP, eco-directed sustainable prescribing; EPV, ecopharmacovigilance.