Patients’ perspectives in German general practice on discussing the environmental impact of medications: A qualitative study

BACKGROUND: Pharmaceuticals represent a major source of carbon emissions in primary care. General practitioners could avoid prescribing climate-harmful medications and consider eco-friendly alternatives in shared decision-making processes. However, evidence on patients' perceptions of discussing medication-specific environmental impacts in primary care consultations in Germany remains limited. OBJECTIVES: To explore patients' perceptions of discussing medications' environmental and climate impact during family medicine encounters and their willingness to switch to more eco-friendly options. METHODS: This qualitative study employed semi-structured interviews with patients recruited through GP practices in Northern Germany. Inclusion criteria were long-term use of at least one medication, legal age, and informed consent. Twenty-five interviews were conducted and analysed using structured content analysis according to Kuckartz. RESULTS: Respondents expressed surprise when environment/climate topics were to be discussed in medical encounters but demonstrated openness to these topics and desired more information about their medications' environmental impact. Many interviewees showed willingness to switch to eco-friendly medications despite potential disadvantages including more frequent intake, increased side effect risk, or co-payments. Patients exhibited high trust in provider recommendations and sought greater information and transparency. CONCLUSION: Results suggest opportunities to incorporate climate/environmental aspects into shared decision-making. Understanding patient perspectives enables GPs to address environmental/climate-friendly medication topics in treatment discussions. Patients are receptive to these discussions and willing to accept eco-friendly alternatives despite potential drawbacks. The high level of trust in provider recommendations positions family physicians as key actors in promoting environmental stewardship.