Other Initiatives

Working Group

About the Community of Practice Primary Care Sustainability Working Group

The Primary Care Sustainability Working Group is focused on identifying and supporting interventions in primary care that can contribute to:

1. Climate mitigation through appropriate use of medications (reduction and alternatives). Reducing unnecessary use of metered-dose inhalers was identified as a high impact opportunity for climate mitigation and quality improvement.  

2. Climate resilience by identifying and providing support to people vulnerable to the impacts of climate change. The Primary Care Working Group is currently working towards developing a pilot intervention.

1. Reducing Unnecessary use of Metered-dose Inhalers

Metered-dose inhalers (MDIs) are common medical devices used to deliver inhaled medication, typically for individuals with asthma or chronic obstructive pulmonary disease (COPD).

MDIs contain high levels of hydrofluorocarbons (HFCs) that act as potent greenhouse gases (GHGs) when released into the atmosphere, contributing to the healthcare sector’s carbon footprint. Hydrofluorocarbons emissions from Metered-dose inhalers mostly come from the use-phase when propellants are released into the atmosphere.

Through continuing professional development and quality improvement, we have been encouraging the following strategies to reduce the carbon impact of inhalers:

• Encourage suitable prescribing practices for inhalers

• Encourage environmentally preferable alternatives to MDIs, such as dry-powder inhalers (DPIs), whenever appropriate

• Facilitate appropriate inhaler technique

• Practice sustainable recovery and recycling of inhalers

We have sought to facilitate provider awareness about the climate impact of inhalers and to foster understanding of how inhalers can be sustainably prescribed.

The Working Group appreciates the support of the Lawrence S. Bloomberg Faculty of Nursing, the Leslie Dan Faculty of Pharmacy, and the University of Toronto Department of Family and Community Medicine.

2. Building Climate Resilience for Vulnerable Persons

Climate change is associated with an increased frequency and severity of severe weather events, the nature of which depends on local weather patterns. In our region, heat waves are one kind of severe weather event that affects health.

Certain people are more vulnerable to the negative health effects of heat waves. Primary care data may be able to identify these people. Cities and regional municipalities may be positioned to provide services that would protect people from negative health outcomes.

The Working Group is currently exploring how we could work with city and regional partners to protect our vulnerable patients from the negative health consequences of heat waves.

On June 1, 2023 the Working Group hosted a Heat Vulnerability Roundtable with the aim to:

• Introduce the idea that primary care and community pharmacy can address heat

• Understand heat risk and vulnerabilities: current knowledge and initiatives

• Discuss potential ways for primary care and community pharmacy to address

  heat risks, and consider what might be needed to achieve those aspirations

For more details on the presentations and discussion, see the event summary and slides. Please find Health Canada’s presentation deck in French here.

Archived Content

Included below are the educational and practice change resources developed and delivered in 2021. These have been updated and incorporated into the CACSADES Playbook. Please visit CASCADES for the most up-to-date resources.

Educational Webinar on Low-Carbon Inhalers

Prescription Renewal Request Letter

Sample letter to patients requiring an MDI prescription renewal outlining the environmental benefits of switching to a DPI.

Developed by Dr. Kimberly Wintemute.

Dear Patient,

Your pharmacy has asked me to renew your salbutamol (blue inhaler).

OR

I am writing about the inhaler that I have prescribed for you in the past.

I wonder if you would you be open to trying a different type of inhaler that delivers the medication better. You’ve been using the “aerosol” inhaler. We are moving away from these because the aerosol that pushes the puff out of the container is a strong greenhouse gas. These kinds of inhalers are worsening the climate change problem.

A greener alternative to your aerosol puffer would be “Bricanyl Turbuhaler”, which produces 10 times less greenhouse gases. It contains the medication called terbutaline, which works the same as salbutamol. It looks like a small cylinder, and is called a “turbuhaler”. There is no aerosol, so it looks, sounds and feels different. Here is a link to a video that shows you how to use it: www.youtube.com/watch?v=02OPJUlsuhQ

Please let me know if you are OK to try the Bricanyl. If you want to talk more about this, please contact the office to set an appointment with me.

Sincerely,

Your Health Care Provider

Pharmaceutical Opinion Letter

Letter than pharmacists can send to a prescriber for a medication recommendation regarding an ODB patient, which they can bill the government for compensation for the recommendation.

Developed by Ms. Jessica Visentin, South East Toronto Pharmacist.

Dear Dr. _______ {prescriber name},

RE: _________________ {patient name} DOB: ____________

This patient requested a refill of their _______ {inhaler name}. We have filled this prescription for the time being, but would like to suggest a switch to ____________ {new inhaler name} in advance of future refills.

This is in an effort to opt for a more environmentally sustainable option, as MDIs use a propellant that contain a potent greenhouse gas and contributes to climate change. 100 doses MDI = 290 km car ride

For more details, see: https://www.sustainablehealthsystems.ca/inhalers

{if suggesting a switch from Ventolin to Symbicort for asthma patient, include the following}

In addition, the latest GINA guidelines recommend combination formeterol-budesonide (Symbicort) first line as both reliever and controller medication for asthma treatment.

{choose one of the following}

Please note, we have discussed this with the patient and they are open to switching inhalers.

OR

Please note, we have not yet had a chance to discuss this with the patient. If you have the opportunity, we would encourage you to do so.

Regards,

Pharmacy Team

Inhaler Prescribing Tracking Tools

These tools have been developed at Unity Health by Dr. Mo Alhaj, Clinical Pharmacist Brenda Chang, Dr. Shima Shakory-Bakhtiar, and Dr. Samantha Green.

If you’d like to share any ideas, questions, or resources, please email cshs@utoronto.ca.