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Grüßer L, Bayram B, Ziemann S, Wallqvist J, Wienhold J, Rossaint R, Derwall M, Follmann A. Teleconsultation for Preoperative Anesthesia Evaluation: Identifying Environmental Potentials by Life Cycle Assessment. Telemed J E Health 2024; 30:e2050-e2058. [PMID: 38656124 DOI: 10.1089/tmj.2023.0700] [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: 04/26/2024] Open
Abstract
Introduction: Teleconsultations for preoperative evaluation in anesthesiology proved to be feasible during the COVID-19 pandemic. However, widespread implementation of teleconsultations has not yet occurred. Besides time savings and economic benefits, teleconsultations in anesthesia may have the potential to reduce CO2 emissions. Methods: We conducted a life cycle assessment based on prospective surveys to assess the potential environmental benefits of preoperative anesthesia teleconsultations in comparison to the status-quo in-person consultations. Within 1 month, all patients presenting at the preoperative anesthesia clinic at RWTH Aachen University Hospital were asked about the distance traveled and mode of transportation to the hospital. The main outcome measure was the potential environmental benefit resulting from the implementation of teleconsultations. Results: In total, 821 out of 981 patients presenting at the anesthesia clinic participated in the survey. Most patients visited on an outpatient basis (62.9%) and traveled by car (81.7%). The median travel distance was 25 km [interquartile range 12-40]. If patients who came to the hospital solely for the anesthesia appointment had scheduled virtual appointments, the emissions of 3.03-ton CO2 equivalents (CO2-eq) could be avoided in the first month after implementation. The environmental impact associated with the production of teleconsultation equipment is outweighed by the reduction in patient travel. If all outpatient appointments were performed virtually, these savings would triple. Within 10 years, more than 1,300 tons CO2-eq could be avoided. Conclusion: Teleconsultations can mitigate the environmental impact of in-person anesthesia consultations. Further research is essential to leverage teleconsultations for preoperative evaluation also across other medical specialties.
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Affiliation(s)
- Linda Grüßer
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Berfin Bayram
- Department Anthropogenic Material Cycles, RWTH Aachen University, Aachen, Germany
| | - Sebastian Ziemann
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Wallqvist
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Wienhold
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Derwall
- Department of Anesthesia, Critical Care and Pain Medicine, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - Andreas Follmann
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
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Khera M, Bernie HL, Broderick G, Carrier S, Faraday M, Kohler T, Jenkins L, Watter D, Mulhall J, Raheem O, Ramasamy R, Rubin R, Spitz A, Yafi F, Sadeghi-Nejad H. Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper. J Sex Med 2024; 21:318-332. [PMID: 38430132 DOI: 10.1093/jsxmed/qdad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 03/03/2024]
Abstract
PURPOSE The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care. LITERATURE SEARCH STRATEGY A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Gregory Broderick
- Department of Urology, Mayo Clinic Alix School of Medicine, Jacksonville, Florida 32224, United States
| | - Serge Carrier
- Surgical Department /Urology Division, McGill University, Montreal, Quebec, H4A 3J1, Canada
| | - Martha Faraday
- Four Oaks Consulting, Berryville, VA 22611, United States
| | - Tobias Kohler
- Department of Urology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lawrence Jenkins
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Daniel Watter
- Morris Psychological Group, P.A., Parsippany, NJ 07054, United States
| | - John Mulhall
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States
| | - Omer Raheem
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL 60637, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Rachel Rubin
- Department of Urology, Georgetown University, Washington, DC 20007, United States
| | - Aaron Spitz
- Orange County Urology Associates, Laguna Hills, California, CA 92653, United States
| | - Faysal Yafi
- Department of Urology, University of California Irvine, CA 92660, United States
| | - Hossein Sadeghi-Nejad
- Department of Urology, NYU Langone Grossman School of Medicine, New York, NY 10017, United States
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Rodler S, Ramacciotti LS, Maas M, Mokhtar D, Hershenhouse J, De Castro Abreu AL, Fuchs G, Stief CG, Gill IS, Cacciamani GE. The Impact of Telemedicine in Reducing the Carbon Footprint in Health Care: A Systematic Review and Cumulative Analysis of 68 Million Clinical Consultations. Eur Urol Focus 2023; 9:873-887. [PMID: 38036339 DOI: 10.1016/j.euf.2023.11.013] [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] [Received: 09/21/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT Carbon footprint (CF) has emerged as an important factor when assessing health care interventions. OBJECTIVE To investigate the reduction in CF for patients utilizing telemedicine. EVIDENCE ACQUISITION The PubMed, Scopus, and Web of Science databases were queried for studies describing telemedicine consultation and reporting on carbon emissions saved and the carbon emissions of telemedicine devices as primary outcomes, and travel distance and time and cost savings and safety as secondary outcomes. Outcomes were tabulated and calculated per consultation. Carbon emissions and travel distances were also calculated for each total study cohort. Risk of bias was assessed using the Newcastle-Ottawa scale, and the Oxford level of evidence was determined. EVIDENCE SYNTHESIS A total of 48 studies met the inclusion criteria, covering 68 465 481 telemedicine consultations and savings of 691 825 tons of CO2 emissions and 3 318 464 047 km of travel distance. Carbon assessment was mostly reported as the estimated distance saved using a conversion factor. Medical specialties used telemedicine to connect specialists with patients at home (n = 25) or at a local center (n = 6). Surgical specialties used telemedicine for virtual preoperative assessment (n = 9), follow-up (n = 4), and general consultation (n = 4). The savings per consultation were 21.9-632.17 min and $1.85-$325. More studies focused on the COVID-19 time frame (n = 33) than before the pandemic (n = 15). The studies are limited by calculations, mostly for the travel distance for carbon savings, and appropriate follow-up to analyze the real impact on travel and appointments. CONCLUSIONS Telemedicine reduces the CF of the health care sector. Expanding the use of telemedicine and educating providers and patients could further decrease CO2 emissions and save both money and time. PATIENT SUMMARY We reviewed 48 studies on the use of telemedicine. We found that people used their cars less and saved time and money, as well as CO2 emissions, if they used teleconsultations. Some studies only looked at how much CO2 from driving was saved, so there might be more to learn about the benefits of teleconsultations. The use of online doctor appointments is not only good for our planet but also helps patients in saving time and money. This review is registered on the PROSPERO database for systematic reviews (CRD42023456839).
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Affiliation(s)
- Severin Rodler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA; Department of Urology, University Hospital of LMU Munich, Munich, Germany
| | - Lorenzo Storino Ramacciotti
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Marissa Maas
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Daniel Mokhtar
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Jacob Hershenhouse
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Andre Luis De Castro Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Gerhard Fuchs
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Christian G Stief
- Department of Urology, University Hospital of LMU Munich, Munich, Germany
| | - Inderbir S Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
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Sillcox R, Blaustein M, Khandelwal S, Bryant MK, Zhu J, Chen JY. Telemedicine Use Decreases the Carbon Footprint of the Bariatric Surgery Preoperative Evaluation. Obes Surg 2023; 33:2527-2532. [PMID: 37407773 DOI: 10.1007/s11695-023-06721-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Healthcare-associated activity accounts for 10% of the United States' carbon dioxide (CO2) emissions. Using telemedicine for bariatric surgery evaluations decreases emissions and reduces patient burden during the multiple required interdisciplinary visits. After adopting telemedicine during COVID, our clinic continues to utilize telemedicine for preoperative bariatric evaluations. We evaluated the reduced environmental impact associated with this practice. METHODS A retrospective review of all new evaluations for vertical sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB) from 2019 and 2021 was conducted. The 2019 year represents pre-pandemic, in-person evaluations and 2021 represents telemedicine evaluations during the COVID pandemic. Carbon emissions were calculated using the Environmental Protection Agency's (EPA's) validated formula of 404g CO2 per car-mile. Preoperative evaluation time was calculated from the initial clinic visit to the operation date. RESULTS There were 51 patients in the 2019 cohort and 55 patients in the 2021 cohort. In the 2019 in-person cohort, there was significantly more kg of estimated CO2 emitted (10,225 vs. 2011.4, p<.001) compared to the 2021 cohort. For time required to complete the preoperative workup, there was no statistically significant difference between the two groups (162 days vs. 193 days, p=.226). The attrition rate was lower in the 2021 cohort (22.22% v. 35.9%, p<.001). CONCLUSIONS Implementation of telemedicine for bariatric preoperative evaluations reduced patient travel, carbon emissions, and improved attrition rate. We encourage bariatric providers to use telemedicine as we believe this eases patient burdens and, with wider adoption, could significantly reduce our carbon footprint.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA.
| | - Megan Blaustein
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Saurabh Khandelwal
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Mary Kate Bryant
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Jay Zhu
- Department of Surgery, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Judy Y Chen
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
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Lambert P, Musto G, Thiessen M, Czaykowski P, Decker K. Impact of Cancer-Related Virtual Visits on Travel Distance, Travel Time, and Carbon Dioxide (CO 2) Emissions during the COVID-19 Pandemic in Manitoba, Canada. Curr Oncol 2023; 30:5973-5983. [PMID: 37504307 PMCID: PMC10378106 DOI: 10.3390/curroncol30070446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023] Open
Abstract
CancerCare Manitoba (CCMB) introduced virtual visits at the beginning of the COVID-19 pandemic to replace many in-person visits. This study examines the impact of virtual visits for cancer care on travel distance, travel time, and carbon dioxide (CO2) emissions. We included all visits to CCMB for invasive and in situ cancers from 1 April 2020 to 31 December 2022. Data were extracted from CCMB's electronic health record. The percentage of visits done virtually by month was reported by age, gender, cancer diagnosis, and regional health authority of residence. Postal codes for patients' residences and clinic locations were converted into latitude and longitude values. Travel distance, travel time, and CO2 emissions associated with travel were estimated. The percentage of virtual visits was highest during the months when COVID-19 restrictions were present in Manitoba and represent more than 50% of such monthly visits. Virtual visits increased with age, were highest among men with urogenital cancer, and were lowest among northern Manitoba residents. The median travel time per visit ranged from 30 min in Winnipeg to 15 h in the Northern Region. The estimated travel distance saved varied from 420,000 to 750,000 km per month. Estimated travel time saved varied from 5500 to 9600 h per month. Estimated CO2 emissions prevented varied from 87 to 155 metric tons per month. Virtual care is an important tool for better supporting those living with cancer by substantially decreasing travel distance and time. Virtual care also contributes to reducing greenhouse gas emissions.
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Affiliation(s)
- Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Grace Musto
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Maclean Thiessen
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3E 0V9, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3E 0V9, Canada
| | - Kathleen Decker
- CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0V9, Canada
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Sillcox R, Gitonga B, Meiklejohn DA, Wright AS, Oelschlager BK, Bryant MK, Tarefder R, Khan Z, Zhu J. The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease. Surg Endosc 2023:10.1007/s00464-023-10131-9. [PMID: 37237107 DOI: 10.1007/s00464-023-10131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Health care accounts for almost 10% of the United States' greenhouse gas emissions, accounting for a loss of 470,000 disability-adjusted life years based on the health effects of climate change. Telemedicine has the potential to decrease health care's carbon footprint by reducing patient travel and clinic-related emissions. At our institution, telemedicine visits for evaluation of benign foregut disease were implemented for patient care during the COVID-19 pandemic. We aimed to estimate the environmental impact of telemedicine usage for these clinic encounters. METHODS We used life cycle assessment (LCA) to compare greenhouse gas (GHG) emissions for an in-person and a telemedicine visit. For in-person visits, travel distances to clinic were retrospectively assessed from 2020 visits as a representative sample, and prospective data were gathered on materials and processes related to in-person clinic visits. Prospective data on the length of telemedicine encounters were collected and environmental impact was calculated for equipment and internet usage. Upper and lower bounds scenarios for emissions were generated for each type of visit. RESULTS For in-person visits, 145 patient travel distances were recorded with a median [IQR] distance travel distance of 29.5 [13.7, 85.1] miles resulting in 38.22-39.61 carbon dioxide equivalents (kgCO2-eq) emitted. For telemedicine visits, the mean (SD) visit time was 40.6 (17.1) min. Telemedicine GHG emissions ranged from 2.26 to 2.99 kgCO2-eq depending on the device used. An in-person visit resulted in 25 times more GHG emissions compared to a telemedicine visit (p < 0.001). CONCLUSION Telemedicine has the potential to decrease health care's carbon footprint. Policy changes to facilitate telemedicine use are needed, as well as increased awareness of potential disparities of and barriers to telemedicine use. Moving toward telemedicine preoperative evaluations in appropriate surgical populations is a purposeful step toward actively addressing our role in health care's large carbon footprint.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA.
| | - Baraka Gitonga
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Andrew S Wright
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Brant K Oelschlager
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Mary Kate Bryant
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Rafiqul Tarefder
- Department of Civil, Construction and Environmental Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Zafrul Khan
- Department of Civil, Construction and Environmental Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Jay Zhu
- Department of Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
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González Villoria M, Jarque Fuertes MJ. [Pilot trial on the detection of patients with undiagnosed diabetes mellitus type 2 performed in community pharmacies in Valladolid. Environmental impact evaluation]. FARMACEUTICOS COMUNITARIOS 2023; 15:12-19. [PMID: 39155963 PMCID: PMC11326678 DOI: 10.33620/fc.2173-9218.(2023).11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/29/2023] [Indexed: 03/05/2023]
Abstract
Introduction The complications that DM2 can develop, and the undiagnosed population (6%) highlight the importance of screening at the population level. The aim of this work is to evaluate and verify whether the professional activity performed in pharmacies is a good point to detect patients with undiagnosed type 2 diabetes mellitus and to refer them for a possible diagnosis. Moreover, to evaluate the environmental impact of the actions. Methodology Findrisc questionnaire for patients who met the inclusion criteria and agreed to participate in the study. Basal capillary blood glucose measurement if the result was ≥15 points and referral to a physician if blood glucose was ≥110mg/dL. Results 44 pharmacies participated. The sample included 434 users; those with high or very high risk (Findrisc ≥15) underwent capillary basal glycemia, with a mean result of 124.51 mg/dL (SD=33.6). Out of the 89 patients referred to the physician (20.5%), the patients diagnosed with diabetes type 2 accounted for 3% of the analyzed sample. Conclusions The number of newly diagnosed patients (3%) reflects that the community pharmacy is a good place for diabetes detection. In addition, the study reveals pharmacists' usefulness in their role as a health educator, since they provide guidance on healthy lifestyle habits to those patients not subject to physician referral. Furthermore, closer collaborations between physicians and pharmacists would be necessary in diabetes screening, since the return of information was low; although we can observe that in rural areas, where the relationship is close, the return rate was 85.2%.
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Affiliation(s)
- Marina González Villoria
- Graduada en Farmacia. Máster en Evaluación y Diseño de Medicamentos. Universidad de SalamancaUniversidad de SalamancaEspaña
- Centro de Información del Medicamento del Colegio Oficial de Farmacéuticos de Valladolid, España.Colegio Oficial de Farmacéuticos de ValladolidEspaña
| | - Maria Jesús Jarque Fuertes
- Doctora en Farmacia. Universidad de
Salamanca. Universidad de SalamancaEspaña
- Centro de Información del Medicamento del Colegio Oficial de Farmacéuticos de Valladolid, España.Colegio Oficial de Farmacéuticos de ValladolidEspaña
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Daza F, Díaz Ritter C, Badillo N. Re: Michael S. Leapman, Cassandra L. Thiel, Ilyssa O. Gordon, et al. Environmental Impact of Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Guided Prostate Biopsy. Eur Urol. 2023;83:463–71. Eur Urol 2023:S0302-2838(23)02705-7. [PMID: 37031004 DOI: 10.1016/j.eururo.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/01/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Fabian Daza
- Department of Urology, University Hospital Fundación Santa Fe de Bogotá, Chia, Colombia
| | - Cesar Díaz Ritter
- Department of Urology, University Hospital Fundación Santa Fe de Bogotá, Chia, Colombia.
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Desterbecq C, Tubeuf S. Inclusion of Environmental Spillovers in Applied Economic Evaluations of Healthcare Products. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023:S1098-3015(23)00106-7. [PMID: 36967027 DOI: 10.1016/j.jval.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Climate change and environmental factors have an impact on human health and the ecosystem. The healthcare sector is responsible for substantial environmental pollution. Most healthcare systems rely on economic evaluation to select efficient alternatives. Nevertheless, environmental spillovers of healthcare treatments are rarely considered whether it is from a cost or a health perspective. The objective of this article is to identify economic evaluations of healthcare products and guidelines that have included any environmental dimensions. METHODS Electronic searches of 3 literature databases (PubMed, Scopus, and EMBASE) and official health agencies guidelines were conducted. Documents were considered eligible if they assessed the environmental spillovers within the economic evaluation of a healthcare product or provided any recommendations on the inclusion of environmental spillovers in the health technology assessment process. RESULTS From the 3878 records identified, 62 documents were deemed eligible and 18 were published in 2021 and 2022. The environmental spillovers considered were carbon dioxide (CO2) emissions, water or energy consumption, and waste disposal. The environmental spillovers were mainly assessed using the lifecycle assessment (LCA) approach while the economic analysis was mostly limited to costs. Only 9 documents, including the guidelines of 2 health agencies presented theoretical and practical ways to include environmental spillovers into the decision-making process. CONCLUSIONS There is a clear lack of methods on whether environmental spillovers should be included in health economic evaluation and how this should be done. If healthcare systems want to reduce their environment footprint, the development of methodology which integrates environmental dimensions in health technology assessment will be key.
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Affiliation(s)
- Charlotte Desterbecq
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UClouvain), Brussels, Belgium.
| | - Sandy Tubeuf
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UClouvain), Brussels, Belgium; Institute of Economic and Social Research (IRES), Université Catholique de Louvain (UClouvain), Brussels, Belgium
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Pickard Strange M, Booth A, Akiki M, Wieringa S, Shaw SE. The role of virtual consulting in developing environmentally sustainable healthcare: a systematic literature review (Preprint). J Med Internet Res 2022; 25:e44823. [PMID: 37133914 DOI: 10.2196/44823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Health systems globally need to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting (including video- and telephone-based consulting) is regarded as one means by which this might be achieved, largely through reduced patient travel. Little is currently known about the ways in which forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programs at scale that can support increased environmental sustainability. OBJECTIVE In this paper, we asked, What is the impact of virtual consulting on environmental sustainability in health care? and What can we learn from current evaluations that can inform future reductions in carbon emissions? METHODS We conducted a systematic review of published literature according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. We searched the MEDLINE, PubMed, and Scopus databases using key terms relating to "carbon footprint," "environmental impact," "telemedicine," and "remote consulting," using citation tracking to identify additional articles. The articles were screened, and full texts that met the inclusion criteria were obtained. Data on the approach to carbon footprinting reported reductions in emissions, and the opportunities and challenges associated with the environmental sustainability of virtual consultations were extracted into a spreadsheet, analyzed thematically, and theorized using the Planning and Evaluating Remote Consultation Services framework to consider the various interacting influences, including environmental sustainability, that shape the adoption of virtual consulting services. RESULTS A total of 1672 papers were identified. After removing duplicates and screening for eligibility, 23 papers that focused on a range of virtual consulting equipment and platforms across different clinical conditions and services were included. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel related to face-to-face appointments. The shortlisted papers used a range of methods and assumptions to determine carbon savings, reporting these using different units and across varied sample sizes. This limited the potential for comparison. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors (eg, patient suitability, clinical indication, and organizational infrastructure) influencing the adoption, use, and spread of virtual consultations and the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (eg, risk of missed diagnoses from virtual consultations that result in the need for subsequent in-person consultations or admissions). CONCLUSIONS There is overwhelming evidence that virtual consulting can reduce health care carbon emissions, largely through reducing travel related to in-person appointments. However, the current evidence fails to look at system factors associated with implementing virtual health care delivery and wider research into carbon emissions across the entire clinical pathway.
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Affiliation(s)
- Martha Pickard Strange
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Melissa Akiki
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- University of Oslo, Oslo, Norway
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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11
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Lokmic-Tomkins Z, Davies S, Block LJ, Cochrane L, Dorin A, von Gerich H, Lozada-Perezmitre E, Reid L, Peltonen LM. Assessing the carbon footprint of digital health interventions: a scoping review. J Am Med Inform Assoc 2022; 29:2128-2139. [PMID: 36314391 PMCID: PMC9667173 DOI: 10.1093/jamia/ocac196] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/16/2022] [Accepted: 10/05/2022] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE Integration of environmentally sustainable digital health interventions requires robust evaluation of their carbon emission life-cycle before implementation in healthcare. This scoping review surveys the evidence on available environmental assessment frameworks, methods, and tools to evaluate the carbon footprint of digital health interventions for environmentally sustainable healthcare. MATERIALS AND METHODS Medline (Ovid), Embase (Ovid). PsycINFO (Ovid), CINAHL, Web of Science, Scopus (which indexes IEEE Xplore, Springer Lecture Notes in Computer Science and ACM databases), Compendex, and Inspec databases were searched with no time or language constraints. The Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA_SCR), Joanna Briggs Scoping Review Framework, and template for intervention description and replication (TiDiER) checklist were used to structure and report the findings. RESULTS From 3299 studies screened, data was extracted from 13 full-text studies. No standardised methods or validated tools were identified to systematically determine the environmental sustainability of a digital health intervention over its full life-cycle from conception to realisation. Most studies (n = 8) adapted publicly available carbon calculators to estimate telehealth travel-related emissions. Others adapted these tools to examine the environmental impact of electronic health records (n = 2), e-prescriptions and e-referrals (n = 1), and robotic surgery (n = 1). One study explored optimising the information system electricity consumption of telemedicine. No validated systems-based approach to evaluation and validation of digital health interventions could be identified. CONCLUSION There is a need to develop standardised, validated methods and tools for healthcare environments to assist stakeholders to make informed decisions about reduction of carbon emissions from digital health interventions.
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Affiliation(s)
- Zerina Lokmic-Tomkins
- School of Nursing and Midwifery, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Shauna Davies
- Faculty of Nursing, University of Regina, Regina, Saskatchewan, Canada
| | - Lorraine J Block
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindy Cochrane
- Brownless Biomedical Library, University of Melbourne, Parkville, Victoria, Australia
| | - Alan Dorin
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia
| | - Hanna von Gerich
- Department of Nursing Science, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Lisa Reid
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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12
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Rahimi-Ardabili H, Magrabi F, Coiera E. Digital health for climate change mitigation and response: a scoping review. J Am Med Inform Assoc 2022; 29:2140-2152. [PMID: 35960171 PMCID: PMC9667157 DOI: 10.1093/jamia/ocac134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Climate change poses a major threat to the operation of global health systems, triggering large scale health events, and disrupting normal system operation. Digital health may have a role in the management of such challenges and in greenhouse gas emission reduction. This scoping review explores recent work on digital health responses and mitigation approaches to climate change. MATERIALS AND METHODS We searched Medline up to February 11, 2022, using terms for digital health and climate change. Included articles were categorized into 3 application domains (mitigation, infectious disease, or environmental health risk management), and 6 technical tasks (data sensing, monitoring, electronic data capture, modeling, decision support, and communication). The review was PRISMA-ScR compliant. RESULTS The 142 included publications reported a wide variety of research designs. Publication numbers have grown substantially in recent years, but few come from low- and middle-income countries. Digital health has the potential to reduce health system greenhouse gas emissions, for example by shifting to virtual services. It can assist in managing changing patterns of infectious diseases as well as environmental health events by timely detection, reducing exposure to risk factors, and facilitating the delivery of care to under-resourced areas. DISCUSSION While digital health has real potential to help in managing climate change, research remains preliminary with little real-world evaluation. CONCLUSION Significant acceleration in the quality and quantity of digital health climate change research is urgently needed, given the enormity of the global challenge.
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Affiliation(s)
- Hania Rahimi-Ardabili
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
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13
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Morau E, Blanc A, Boisson C, Sawyers T, Lefrant J, Cuvillon P. Telemedicine for Preanesthesia Consultations During the First COVID-19 Lockdown. Telemed J E Health 2022; 29:621-624. [PMID: 35877785 DOI: 10.1089/tmj.2022.0143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: In an effort to avoid travel and interpersonal contact, the COVID-19 health crisis was an opportunity to offer preanesthesia teleconsultation (TCs) to patients scheduled for surgery. Materials and Methods: We studied the technical feasibility and patient experiences of these TCs using a 4-point Likert scale questionnaire. Results: Eighty-six patients out of 139 responded. Technical difficulties (no connection, picture, or sound) occurred in 24% of cases. The patient's experience was considered very positive both in terms of feelings and understanding instructions: 4 (4-4). No deprogramming was required. Conclusion: TCs were approved by patients despite technical problems. Further studies are required to ensure that this type of consultation is not inferior to face-to-face consultations. NCT04920604.
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Affiliation(s)
- Estelle Morau
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - Arthur Blanc
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - Christophe Boisson
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - Teresa Sawyers
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - JeanYves Lefrant
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - Philippe Cuvillon
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
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14
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Naik N, Nandyal SR, Nayak SG, Shah M, Ibrahim S, Hameed BMZ, Patil A, Suresh G, Shetty PA, Rai BP, TP R, Rice P, Reddy SJ, Bhat N, Garg D, Chlosta P, Somani BK. Telemedicine and Telehealth in Urology: Uptake, Impact and Barriers to Clinical Adoption. Front Surg 2022; 9:911206. [PMID: 35846972 PMCID: PMC9280027 DOI: 10.3389/fsurg.2022.911206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Telemedicine has great potential in urology as a strong medium for providing patients with continuous high-quality urological care despite the hurdles involved in its implementation. Both clinicians and patients are crucial factors in determining the success of tele-consults in terms of simplicity of use and overall satisfaction. For it to be successfully incorporated into routine urological practice, rigorous training and evidence-based recommendations are lacking. If these issues are addressed, they can provide a significant impetus for future tele-consults in urology and their successful deployment, even beyond the pandemic, to assure safer and more environment-friendly patient management.
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Affiliation(s)
- Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
| | - Shreyas Raghavan Nandyal
- Gandhi Medical College, Kaloji Narayana Rao University of Health Sciences, Secunderabad, Telangana, India
| | - Sanjana Ganesh Nayak
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Milap Shah
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Robotics and Urooncology, Max Hospital and Max Institute of Cancer Care, New Delhi, India
| | - Sufyan Ibrahim
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B. M. Zeeshan Hameed
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
- Correspondence: B. M. Zeeshan Hameed
| | - Ananth Patil
- A.J. Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India
| | - Gopika Suresh
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pritam A. Shetty
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhavan Prasad Rai
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Rajeev TP
- Department of Urology, Government Medical College Hospital, Guwahati, India
| | - Patrick Rice
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Suraj Jayadeva Reddy
- Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nandakishore Bhat
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Deepesh Garg
- Department of Information and Communication Technology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University in Krakow, Kraków, Poland
| | - Bhaskar K. Somani
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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15
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Lange O, Plath J, Dziggel TF, Karpa DF, Keil M, Becker T, Rogowski WH. A Transparency Checklist for Carbon Footprint Calculations Applied within a Systematic Review of Virtual Care Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127474. [PMID: 35742724 PMCID: PMC9223517 DOI: 10.3390/ijerph19127474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023]
Abstract
Increasing concerns about climate change imply that decisions on the digitization of healthcare should consider evidence about its carbon footprint (CF). This study aims to develop a transparency catalogue for reporting CF calculations, to compare results, and to assess the transparency (reporting quality) of the current evidence of virtual care (VC) intervention. We developed a checklist of transparency criteria based on the consolidation of three established standards/norms for CF calculation. We conducted a systematic review of primary studies written in English or German on the CF of VC interventions to check applicability. Based on our checklist, we extracted methodological information. We compared the results and calculated a transparency score. The checklist comprises 22 items in the aim, scope, data and analysis categories. Twenty-three studies out of 1466 records were included, mostly addressing telemedicine. The mean transparency score was 38% (minimum 14%, maximum 68%). On average, 148 kg carbon dioxide equivalents per patient were saved. Digitization may have co-benefits, improving care and reducing the healthcare CF. However, the evidence for this is weak, and CF reports are heterogeneous. Our transparency checklist may serve as a reference for developing a standard to assess the CF of virtual and other healthcare and public health services.
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Affiliation(s)
- Oliver Lange
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, 28359 Bremen, Germany; (M.K.); (W.H.R.)
- Leibniz ScienceCampus Digital Public Health Bremen, 28359 Bremen, Germany
- Correspondence:
| | - Julian Plath
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, 28359 Bremen, Germany; (J.P.); (T.F.D.); (T.B.)
| | - Timo F. Dziggel
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, 28359 Bremen, Germany; (J.P.); (T.F.D.); (T.B.)
| | - David F. Karpa
- Faculty of Business Studies and Economics, University of Bremen, 28359 Bremen, Germany;
| | - Mattis Keil
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, 28359 Bremen, Germany; (M.K.); (W.H.R.)
| | - Tom Becker
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, 28359 Bremen, Germany; (J.P.); (T.F.D.); (T.B.)
| | - Wolf H. Rogowski
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, 28359 Bremen, Germany; (M.K.); (W.H.R.)
- Leibniz ScienceCampus Digital Public Health Bremen, 28359 Bremen, Germany
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16
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Donald N, Irukulla S. Greenhouse Gas Emission Savings in Relation to Telemedicine and Associated Patient Benefits: A Systematic Review. Telemed J E Health 2022; 28:1555-1563. [PMID: 35446668 DOI: 10.1089/tmj.2022.0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Telemedicine is a rapidly expanding service in the digitization of health care systems. Recently emphasis has been placed on the decarbonization of health care systems with National and World Health Organization initiatives aimed at carbon neutrality toward the mid-21st century. This study investigates greenhouse gas emissions related to telemedicine, its potential role in achieving carbon neutrality and its role in determining policy. We further investigate patient benefits related to telemedicine. Methods: A systematic review was conducted of the PubMed, Medline, EMBASE, EMCARE, CINAHL, and HMIC databases. Eligibility of studies was determined by predefined criteria. Results: A total of 31 studies were identified totaling over 57,000 patients. Carbon savings ranged from 0.69 kg CO2e (carbon dioxide equivalent) to 893 kg CO2e per encounter. Distances saved also ranged from 6.1 to 3,386 km. Further analysis of 18 included studies was conducted for cost savings that ranged from €1.73 in fuel costs to over U.S. $900 in travel related expenses. Similarly, 15 included studies were analyzed for time savings, which ranged from 38 min to 24 h. Conclusions: There are substantial carbon savings to be made with telemedicine systems. Furthermore, there are substantial benefits to patients in terms of both time savings and cost savings. Rural and isolated communities or patients needing tertiary or quaternary care may be a particular cohort that might benefit disproportionally from telemedicine and is an area where the largest per capita emission savings can potentially be made.
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Affiliation(s)
- Neil Donald
- West Herts Teaching Hospitals NHS Trust, Watford, United Kingdom
| | - Shashi Irukulla
- Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, United Kingdom
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