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Neal SM, Greenberg MJ. Identifying policy alternatives to enable the virtual establishment of a veterinarian-client-patient relationship. J Feline Med Surg 2024; 26:1098612X231224167. [PMID: 38478919 PMCID: PMC10983609 DOI: 10.1177/1098612x231224167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVES This research seeks to identify an existing policy stream around the establishment of a veterinarian-client-patient relationship (VCPR) through telemedicine to provide evidence of, and advance policy alternatives for, states and countries looking to allow this practice responsibly. This is seen as an important step for access to veterinary care, particularly for cats. METHODS The multiple streams policy framework requires identification of a centering event, problem stream, policy stream and politics stream in order to have the necessary conditions for policy change to occur. This research identifies that policy stream through thematic content analysis. State-level policies from across the entire USA that address the virtual establishment of a physician-patient relationship were analyzed to provide themes that could be applied to similar policies in veterinary medicine. RESULTS Ten key themes were identified and further organized into four high-order concepts through the thematic content analysis. Detailed accounting of the specific policy alternatives is provided in the supplementary materials. CONCLUSIONS AND RELEVANCE The themes and concepts presented provide evidence of a robust policy stream. This content analysis, and the supporting supplementary details, provide many options to guide states in the development of sound policies for the virtual establishment of a VCPR by drawing from the more matured field of human medicine.
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Affiliation(s)
- Sue M Neal
- Department of Political Science, Arkansas State University, Jonesboro, AR, USA
- Veterinary Care Accessibility Project, Rochester, MI, USA
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Forner D, Purcell C, Taylor V, Noel CW, Pan L, Rigby MH, Corsten M, Trites JR, Eskander A, McDonald T, Taylor SM. Carbon footprint reduction associated with a surgical outreach clinic. J Otolaryngol Head Neck Surg 2021; 50:26. [PMID: 33875009 PMCID: PMC8054848 DOI: 10.1186/s40463-021-00510-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Healthcare systems generate substantial carbon footprints that may be targeted to decrease greenhouse gas emissions. Outreach clinics may represent tools to assist in this reduction by optimizing patient related travel. Therefore, we sought to estimate the carbon footprint savings associated with a head and neck surgery outreach clinic. METHODS This study was a cross-sectional survey of patient travel patterns to a surgical outreach clinic compared to a regional cancer treatment centre from December 2019 to February 2020. Participants completed a self-administered survey of 12 items eliciting travel distance, vehicle details, and ability to combine medical appointments. Canadian datasets of manufacturer provided vehicular efficiency were used to estimate carbon emissions for each participant. Geographic information systems were used for analyses. RESULTS One hundred thirteen patients were included for analysis. The majority of patients (85.8%) used their own personal vehicle to travel to the outreach clinic. The median distance to the clinic and regional centre were 29.0 km (IQR 6.0-51.9) and 327.0 km (IQR 309.0-337.0) respectively. The mean carbon emission reduction per person was therefore 117,495.4 g (SD: 29,040.0) to 143,570.9 g (SD: 40,236.0). This represents up to 2.5% of an average individual's yearly carbon footprint. Fewer than 10% of patients indicated they were able to carpool or group their appointments. CONCLUSION Surgical outreach clinics decrease carbon footprints associated with patient travel compared to continued care at a regional centre. Further research is needed to determine possible interventions to further reduce carbon emissions associated with the surgical care of patients.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Chad Purcell
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Victoria Taylor
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Larry Pan
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Radiation Oncology, Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R Trites
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Schwerdtle PN, Maxwell J, Horton G, Bonnamy J. '12 tips for teaching environmental sustainability to health professionals'. MEDICAL TEACHER 2020; 42:150-155. [PMID: 30676137 DOI: 10.1080/0142159x.2018.1551994] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: As recognition of the health impacts of climate change and other environmental challenges increases, so too does the need for health care professionals to practice healthcare sustainably. Environmental sustainability in healthcare extends beyond our traditional understanding of environmental health, which is often limited to environmental hazards and disease. Health services, professional organizations, and training institutions are increasingly forming climate and sustainability position statements and policies accordingly. To prepare future health professionals for global environmental change, environmental sustainability must be meaningfully integrated into health curricula.Aim: To provide educators with 12 tips for integrating environmental sustainability into health professional education.Methods: The authors reviewed the literature relating to climate change, environmental sustainability and health, and health professional education. By combining findings from this search with reflections on their own experience in clinical and public health teaching across nursing and midwifery, paramedicine, medicine, and public health, the authors developed recommendations for integrating environmental sustainability into health professional education.Results: These 12 tips can be used to teach students and qualified health professionals in nursing, allied health, and medicine to practice healthcare in an environmentally sustainable manner.Conclusions: Empowering health professionals to practice environmentally sustainable healthcare has economic, social, health, and environmental benefits. Teaching environmental sustainability to health professionals enhances existing learning by updating curricula with the latest evidence of how environmental determinants of health are rapidly changing and enables both educators and students to make an important contribution to safeguarding human health, the environment, and healthcare for future generations.
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Affiliation(s)
| | - Janie Maxwell
- The Nossal Institute for Global Health, The University of Melbourne, Australia
| | - Graeme Horton
- School of Medicine and Public Health, University of Newcastle, Australia
| | - James Bonnamy
- Nursing and Midwifery, Faculty of Medicine Nursing and Health Science, Monash University, Australia
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Richardson J, Grose J, Bradbury M, Kelsey J. Developing awareness of sustainability in nursing and midwifery using a scenario-based approach: Evidence from a pre and post educational intervention study. NURSE EDUCATION TODAY 2017; 54:51-55. [PMID: 28477563 DOI: 10.1016/j.nedt.2017.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/12/2017] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The delivery of healthcare has an impact on the environment and contributes to climate change. As a consequence, the way in which nurses and midwives use and dispose of natural resources in clinical practice, and the subsequent impact on the environment, should be integral component of nursing and midwifery education. Opportunities need to be found to embed such issues into nursing curricula; thus bringing sustainability issues 'closer to home' and making them more relevant for clinical practice. OBJECTIVES The study was designed to measure the impact of a sustainability-focussed, scenario-based learning educational intervention on the attitudes and knowledge of student nurses and midwives. DESIGN Pre test/Post test intervention study using scenario-based learning as the educational intervention. The Sustainability Attitudes in Nursing Survey (SANS_2) was used as the outcome measure. SETTINGS Clinical skills session in a UK University School of Nursing and Midwifery. PARTICIPANTS 676 second year undergraduate nursing and midwifery students. METHODS The 7-point scale SANS survey was completed before and after the teaching session; standard non-parametric analysis compared pre and post intervention scores. RESULTS Changes were observed in attitude towards climate change and sustainability and to the inclusion of these topics within the nursing curricula (p=0.000). Participants demonstrated greater knowledge of natural resource use and the cost of waste disposal following the session (p=0.000). Participants also reported that sessions were realistic, and levels of agreement with statements supporting the value of the session and the interactive nature of delivery were higher following the session. CONCLUSIONS Using a scenario-based learning approach with nursing and midwifery students can change attitudes and knowledge towards sustainability and climate change. Embedding this approach in the context of clinical skills provides a novel and engaging approach that is both educationally sound and clinically relevant.
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Affiliation(s)
- Janet Richardson
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Jane Grose
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Martyn Bradbury
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Janet Kelsey
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom.
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Understanding and knowledge of sustainable waste management within the neonatal unit: A qualitative investigation. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jnn.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nichols A, Grose J, Mukonoweshuro R. Achieving cost and carbon savings in neonatal practice: A review of the literature on sustainable waste management. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jnn.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Barrett B, Charles JW, Temte JL. Climate change, human health, and epidemiological transition. Prev Med 2015; 70:69-75. [PMID: 25434735 PMCID: PMC4342988 DOI: 10.1016/j.ypmed.2014.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/09/2014] [Accepted: 11/20/2014] [Indexed: 01/18/2023]
Abstract
The health of populations depends on the availability of clean air, water, food, and sanitation, exposure to pathogens, toxins and environmental hazards, and numerous genetic, behavioral and social factors. For many thousands of years, human life expectancy was low, and population growth was slow. The development of technology-based civilizations facilitated what Abdel Omran called "epidemiological transition," with increasing life expectancy and rapid population growth. To a large extent, the spectacular growth of human populations during the past two centuries was made possible by the energy extracted from fossil fuels. We have now learned, however, that greenhouse gases from fossil fuel combustion are warming the planet's surface, causing changes in oceanic and atmospheric systems, and disrupting weather and hydrological patterns. Climate change poses unprecedented threats to human health by impacts on food and water security, heat waves and droughts, violent storms, infectious disease, and rising sea levels. Whether or not humanity can reduce greenhouse gas emissions quickly enough to slow climate change to a rate that will allow societies to successfully adapt is not yet known. This essay reviews the current state of relevant knowledge, and points in a few directions that those interested in human health may wish to consider.
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Affiliation(s)
- Bruce Barrett
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, University of Wisconsin-Madison, 1100 Delaplaine Street, Madison, WI 53715, United States..
| | - Joel W Charles
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, University of Wisconsin-Madison, 1100 Delaplaine Street, Madison, WI 53715, United States
| | - Jonathan L Temte
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, University of Wisconsin-Madison, 1100 Delaplaine Street, Madison, WI 53715, United States
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Nichols A. The impact of the clinical environment on family centred care in the neonatal unit: A qualitative investigation. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jnn.2014.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Carbon footprint of patient journeys through primary care: a mixed methods approach. Br J Gen Pract 2014; 63:e595-603. [PMID: 23998839 DOI: 10.3399/bjgp13x671579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The NHS has a target of cutting its carbon dioxide (CO2) emissions by 80% below 1990 levels by 2050. Travel comprises 17% of the NHS carbon footprint. This carbon footprint represents the total CO2 emissions caused directly or indirectly by the NHS. Patient journeys have previously been planned largely without regard to the environmental impact. The potential contribution of 'avoidable' journeys in primary care is significant. AIM To investigate the carbon footprint of patients travelling to and from a general practice surgery, the issues involved, and potential solutions for reducing patient travel. DESIGN AND SETTING A mixed methods study in a medium-sized practice in Yorkshire. METHOD During March 2012, 306 patients completed a travel survey. GIS maps of patients' travel (modes and distances) were produced. Two focus groups (12 clinical and 13 non-clinical staff) were recorded, transcribed, and analysed using a thematic framework approach. RESULTS The majority (61%) of patient journeys to and from the surgery were made by car or taxi; main reasons cited were 'convenience', 'time saving', and 'no alternative' for accessing the surgery. Using distances calculated via ArcGIS, the annual estimated CO2 equivalent carbon emissions for the practice totalled approximately 63 tonnes. Predominant themes from interviews related to issues with systems for booking appointments and repeat prescriptions; alternative travel modes; delivering health care; and solutions to reducing travel. CONCLUSION The modes and distances of patient travel can be accurately determined and allow appropriate carbon emission calculations for GP practices. Although challenging, there is scope for identifying potential solutions (for example, modifying administration systems and promoting walking) to reduce 'avoidable' journeys and cut carbon emissions while maintaining access to health care.
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Naylor C, Appleby J. Environmentally sustainable health and social care: Scoping review and implications for the English NHS. J Health Serv Res Policy 2013. [DOI: 10.1177/1355819613485672] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To review the evidence on environmental sustainability in health and social care, describe what the implications of sustainability might be for service models and policy, and explore the connection between environmental and financial sustainability. Methods Literature review of 78 published articles and qualitative analysis of 28 semi-structured interviews. Results Provision of health and social care has a substantial impact on the environment, and opportunities exist at a number of levels to deliver services in a more sustainable way. While there is some scope to improve efficiency at the operational level, significant improvements in sustainability may require a more fundamental transformation in service models, for example, with a stronger emphasis on prevention. The current policy framework in England is perceived to create a number of barriers that discourage professionals from redesigning services in ways which could promote both environmental and financial sustainability. Conclusions Increasingly, health and social care will need to be delivered in ways that are not only financially sustainable, but environmentally sustainable too. Close conceptual connections exist with improving productivity – focusing on cost-effectiveness, value and prevention of avoidable activity could enhance sustainability from both an environmental and a financial perspective. Priorities for health care organisations could include prevention, exploring the opportunities presented by new technologies, and improving medicines management and prescribing practices. Policy-makers need to explore what changes are needed to create a more enabling environment, as well as how existing policies can be delivered in the most sustainable way.
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How can a climate change perspective be integrated into public health surveillance? Public Health 2012; 126:660-7. [PMID: 22770738 DOI: 10.1016/j.puhe.2012.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/27/2012] [Accepted: 04/27/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Climate change may be considered as a key factor for environmental change, exposure to health risks and pathogens, consequently impairing the state of health among populations. Efficient health surveillance systems are required to support adaptation to climate change. However, despite a growing awareness, the public health surveillance sector has had very little involvement in the drafting of adaptation plans. This paper proposes a method to raise awareness about climate change in the public health community, to identify possible health risks and to assess the needs for reinforced health surveillance systems. METHODS A working group was set up comprising surveillance experts in the following fields: environmental health; chronic diseases and; infectious diseases. Their goal was to define common objectives, to propose a framework for risk analysis, and to apply it to relevant health risks in France. RESULTS The framework created helped to organize available information on climate-sensitive health risks, making a distinction between three main determinants as follows: (1) environment; (2) individual and social behaviours; and (3) demography and health status. The process is illustrated using two examples: heatwaves and airborne allergens. CONCLUSION Health surveillance systems can be used to trigger early warning systems, to create databases which improve scientific knowledge about the health impacts of climate change, to identify and prioritize needs for intervention and adaptation measures, and to evaluate these measures. Adaptation requires public health professionals to consider climate change as a concrete input parameter in their studies and to create partnerships with professionals from other disciplines.
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Nichols A, Richardson J. Climate change, health and sustainability: A brief survey of primary care trusts in the south west of England. Perspect Public Health 2010; 131:82-4. [DOI: 10.1177/1757913910379196] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With climate change threatening to present real challenges to public health, the relevant UK organizations, such as the NHS, have produced guidelines and action plans to encourage primary care trusts (PCTs) to reduce their carbon emissions and generally function in a more sustainable way. This paper presents the results of a survey designed to assess how successful this initiative has been in one part of the UK, the south west of England. While the results are promising, the PCTs surveyed are aware that commitment and leadership must come from a higher level.
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Affiliation(s)
- Andrew Nichols
- Faculty of Health, University of Plymouth, 3 Portland Villas, Drake Circus, Plymouth, Devon, PL4 8AA, UK,
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