Carbon Reduction Impact from Synchronising PrescriptionS (CRISPS): A pilot study
Authors: Cork T , White S 
Published: April 2024

Abstract

Introduction
Synchronising the dates of patients’ repeat prescriptions can reduce monthly community pharmacy visits or home deliveries, which may improve patients’ adherence to medicines.[1] It should also reduce carbon dioxide (CO2) emissions associated with avoidable travel, but previous research does not appear to have determined the potential size of this reduction. This pilot study therefore attempted to do so using routinely collected data.

Aim
To estimate potential carbon savings from synchronising repeat medicines for a sample of patients from one community pharmacy.

Methods
All patients who had prescriptions dispensed four times per month or more from a single medium-sized (approximately 2,500 items dispensed per month) urban community pharmacy in England were identified from the pharmacy’s home delivery application. The threshold of four deliveries per month was selected to increase the likelihood of this frequency being due to asynchronised prescriptions. Data were collected (August 2023) for deliveries in June 2023 as there were no public holidays or events to affect prescription ordering. Data included patients’ postcode, delivery dates, and using the Patient Medication Record, the pharmacist collecting the data determined acute or one-off prescription items, that neither the patients nor the repeat medicines were new, and where deliveries were made to supply medicines owing. The pharmacy was selected because it efficiently managed stock to minimise items owing. The distance that would have been travelled was calculated as if the medicines had been collected from the pharmacy as a dedicated journey to and from the patient’s home address instead of being delivered. The saving in miles and CO2 emitted for different vehicle types was modelled by assuming that for each patient, all deliveries that were not for acute items or medicines owing could have been reduced to a single delivery if prescriptions had been synchronised. UK Government conversion factors were used to calculate CO2 emissions.[2]

Results
Data were collected for 59 patients, of whom 7 patients had 8 deliveries, 4 had 7 deliveries, 6 had 6 deliveries, 16 had 5 deliveries and 26 had 4 deliveries. The total number of deliveries to these patients was 269 but would have been 80 deliveries if the repeat prescriptions had been synchronised (70% reduction). The distance travelled would have been reduced from 842 miles to 241 miles (71% reduction). This would have resulted in a 71% reduction in CO2 emissions, although the reduction in volume in kilograms of CO2 emitted would have varied (by an estimated 137 Kg CO2 or 51%) depending on whether e.g., a small diesel car was used or a large petrol car (reduction of 133kg versus 270 kg CO2). An average diesel car was estimated to have reduced CO2 emissions by 163 kg.

Conclusion
The findings demonstrate that potential carbon savings from medicines synchronisation can be modelled from routinely collected data, but with limited accuracy, especially as patients receiving home deliveries may not be representative of all pharmacy users. Challenges remain in how to measure actual carbon savings of prescription synchronisation and overcoming barriers to widespread implementation of clinically appropriate synchronisation.

References
1. Nguyen E, Sobieraj D. The impact of appointment-based medication synchronization on medication taking behaviour and health outcomes: A systematic review. J Clin Pharm Ther, 2017; 42: 404-413.
2. Department for Energy Security and Net Zero. Greenhouse gas conversion factors 2021 (last updated January 2022). Available at: https://www.gov.uk/government/publications/greenhouse-gas-reporting-conversion-factors-2021#full-publication-update-history