-->PONE-D-25-44528-->-->Towards Sustainable Pharmacy Practice: Community Pharmacists’ Experiences with Medicine Waste and Disposal-->-->PLOS ONE

Dear Dr. Rajiah,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

• Strengthen introduction with rationale, context, and conceptual figure.
• Clarify coding process, reflexivity, manual approach, and add COREQ checklist.
• Distinguish overlapping themes in Results.
• Reframe discussion with higher-level synthesis and integration with literature.
• Embed global policy/SDG connections earlier in the paper.
• Revise conclusion for conciseness and alignment.

Please submit your revised manuscript by  Nov 16 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Muhammad Shahzad Aslam, Ph.D.,M.Phil., Pharm-D

Academic Editor

PLOS ONE

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Additional Editor Comments:

1-Strengthen the rationale and narrative arc. Clarify why this study was conducted, and situate it clearly within global and Northern Ireland contexts.

2-Expand background on pharmacy services in Northern Ireland and how waste/disposal practices compare with other regions.

3-Consider including a figure that illustrates the lifecycle of medicines and potential pharmacist intervention points (deprescribing, disposal, patient education).

4-Line 70: provide more details on the framework mentioned.

5-Explicitly state who performed the coding (using initials) and include this in the reflexivity statement.

6-Clarify whether coding was done manually (e.g., Microsoft Word, NVivo, pen-and-paper).

7-Include the COREQ checklist as a supplementary file and confirm completeness.

8-Distinguish more clearly between Theme 5 (Economic impact of waste) and Theme 7 (Barriers to reuse). Currently, the same quotations are repeated for both, which blurs thematic boundaries. Consider reassigning or expanding quotes to avoid duplication.

9-The discussion needs a stronger synthesis. Currently, it reiterates theme-level findings rather than elevating them into higher-level insights.

10-Integrate findings with wider literature (beyond Northern Ireland) and highlight pharmacists’ potential as environmental stewards—a concept well introduced in lines 352–358 but needing greater emphasis throughout.

11-Link discussion points more explicitly to global policies and UN Sustainable Development Goals.

12- Provide more indepth study limitation to address all potential bias.

13- Expand future direction and provide more details.

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Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

Reviewer #2: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: N/A

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-->3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

Reviewer #2: No

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-->4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: This is a well-written and engaging paper on a relevant topic. The use of purposive sampling and manual thematic analysis is appropriate, though I suggest adding a little more detail on how the coding and theme development were carried out to show rigor and transparency. Overall, the study is strong, and I support acceptance with only minor revisions.

Reviewer #2: Thank you for the opportunity to review this manuscript titled “Towards Sustainable Pharmacy Practice: Community Pharmacists’ Experiences with Medicine Waste and Disposal”. I believe the topic is of importance and warrants discussion in the literature. I enjoyed reading the manuscript and have some questions/comments below.

Methods

I found the methods to be robust and very well written.

Line 107-113 - move to introduction as part of your rationale and justification for your study. This is not methods

Make clear who did the coding by using the initials and add this to the reflexivity

Line 166 - coding was done manually… using microsoft word, pen and paper, etc.?

Add Consolidated criteria for reporting qualitative research (COREQ) checklist and confirm it’s complete

Add ethics information

Introduction

The introduction needs to be strengthened and really make it clear what the story is that you are telling and the rationale for your study.

The intro relies on some assumed knowledge that I am unclear the readers will have.

The intro would benefit from a figure and discussion of the cycle of medicines and where pharmacists can be involved to reduce waste - deprescribing, disposal etc.

We need a better understanding of pharmacy in Northern Ireland, then how medication waste practices occur in other regions around the world and the direct comparison to how it is managed in Northern Ireland.

Line 62-63 - the part of the sentence about 'theoretically suitable for redistribution' doesn't align with the rest of the paragraph and introduction, either expand this point or remove it.

Line 70 - what is the framework? provide more details

Line 79-80 - how does the mix of urban and rural and centralized prescription system offer solutions? Also, what are the solutions?

Line 81 - what barriers are you referring to? I am missing the link to this sentence from the previous ones.

Results

Line 220 - Did the pharmacists do anything to raise literacy or awareness?

Theme 5 and 7 Lines 269-272 and 290-295. The same quotes have been used to illustrate the same point (pharmacists find disposal wasteful and want to reuse unopened meds) but under 2 different themes. Theme 5 seems to have 2 main points - (1) cost to the pharmacy to dispose of the returned meds and (2) perspective of wastefulness for destroying unopened boxes. It is unclear how this second point in Theme 5 differs from Theme 7. I encourage the authors to review and make the distinction clearer.

Discussion

Similarly to the introduction, the discussion needs to be strengthened and really make it clear what the story is that you are telling and the positioning within the knowledge to address the reader’s - SO WHAT?

It is of my opinion that the discussion rephrases and focuses on the paper’s results at the theme level too much. I was looking for more of a higher level synthesis of the results and the comparison of that with existing literature. Your manuscript has me thinking of the lifecycle of medicines and all the touchpoints and ways pharmacists can intervene as environmental stewards - deprescribing, reducing stockpiles, disposing correctly etc. This could be the structure and outline for the discussion and how to meaningfully weave your results with existing literature, leading to an implication for practice of standardized policies for the return of meds.

Line 352-358 - this discussion about pharmacists as environmental stewards is brilliant and I was hoping for more of this throughout the discussion.

Conclusion

Line 571-573 - this is the first mention of these global policies, they should be weaved into the introduction and discussion. They are a great justification and rationale as pharmacists as environment stewards.

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-->6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #1: Yes:Farwa Tahir

Reviewer #2: Yes:Kaitlyn Watson

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Towards sustainable pharmacy practice: community pharmacists’ experiences with medicine waste, reuse and disposal

PONE-D-25-44528R1

Dear Dr. Rajiah,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Muhammad Shahzad Aslam, Ph.D.,M.Phil., Pharm-D

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #2: All comments have been addressed

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-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #2: Yes

**********

-->3. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #2: Yes

**********

-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #2: Yes

**********

-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #2: Yes

**********

-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #2: Thank you to the authors for their detailed and thoughtful revisions. The paper is stronger and clearer in its message and has an important place in the literature. I have no further comments.

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-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #2: Yes:Kaitlyn E Watson

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