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Wicklum SC, Nuique K, Kelly MA, Nesbitt CC, Zhang JJ, Svrcek CP. Greening Family Medicine clinic operations and clinical care, where do we start? A scoping review of toolkits and aids. Fam Pract 2023; 40:473-485. [PMID: 36730055 DOI: 10.1093/fampra/cmad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is a pressing need for healthcare to respond to the climate crisis. Family physicians, given their central role in community healthcare provision, are strategically placed to lead, support, and promote sustainable healthcare, yet guidance on how to do this is fragmented. OBJECTIVE To identify and evaluate toolkits and aids on sustainable healthcare to act as a curated resource for family physicians and their care teams interested in delivering evidence-based sustainable healthcare in their clinical practices. METHODS A scoping review was completed of the published and grey literature across 4 databases and 2 search engines to identify articles and aids/toolkits from 1990 to present. Toolkits were subsequently evaluated for purpose, evidence-base, implementation process, adaptability to family medicine, and outcome measures. RESULTS The search identified 17,751 articles. Screening resulted in 20 published articles and 11 toolkits. Most articles presented simple checklists to support greening clinic initiatives, 3 studies focussed on partial carbon footprint analyses, and 4 on educational initiatives. Toolkits ranged in sustainability topics and degree of depth covered, and adaptability and outcome measures. None of the resources identified have been formally evaluated for effectiveness. CONCLUSIONS A range of aids exist to support greening of clinic operations; however, there is a significant gap in the literature for greening clinical care. Two toolkits were found to be comprehensive, one requiring tracking and reporting of sustainability initiatives. This scoping review provides a starting point for motivated family doctors and community clinics to initiate change and support more sustainable healthcare.
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Affiliation(s)
- Sonja C Wicklum
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Kate Nuique
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Martina A Kelly
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Colleen C Nesbitt
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Jessica J Zhang
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Clark P Svrcek
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
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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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Behera MR, Behera D, Satpathy SK. Planetary health and the role of community health workers. J Family Med Prim Care 2020; 9:3183-3188. [PMID: 33102267 PMCID: PMC7567207 DOI: 10.4103/jfmpc.jfmpc_328_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/27/2020] [Accepted: 06/03/2020] [Indexed: 11/08/2022] Open
Abstract
In this era, grand challenges lies in biodiversity loss, climate change, and global noncommunicable diseases signify that planet and humanity are in crisis. Scholarly evidence from human and animal kingdom suggest that there is an optimism in planetary health which can provide a unique and novel concept where efforts toward survival and remediation can be made. With accurate navigation, the current challenges can be mitigated leading to a new reality, one in which the core value is the well-being of all. This paper discusses the drivers of planetary health and the role of community health workers (CHWs) in making health-care system more resilient that can produce multiple benefits to community and overall planetary health. A web-based international database such as Google, Google Scholar, SCOPUS/MEDLINE/PubMed, and JSTOR was searched relevant to a planetary health framework. The study findings suggest that CHWs can offer health care interventions through environmental health cobenefits across the spectrum of health effects of climate change cause and effects. These actions have been divided into four major categories (i. health care promotion and prevention, ii. health care strengthening, iii. advocacy, and iv. education and research) that CHWs perform through a variety of roles and functions they are engaged in protecting planetary health. CHWs contribute toward achieving sustainable development goals such as planetary health and focus on environment sustainability and well-being of entire mankind.
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Affiliation(s)
- Manas R Behera
- School of Public Health, Kalinga Institute of Industrial Technology (KIIT) University, Bhubaneswar, Odisha, India
| | - Deepanjali Behera
- School of Public Health, Asian Institute of Public Health (AIPH) University, Bhubaneswar, Odisha, India
| | - Sudhir K Satpathy
- School of Public Health, Kalinga Institute of Industrial Technology (KIIT) University, Bhubaneswar, Odisha, India
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Xie E, de Barros EF, Abelsohn A, Stein AT, Haines A. Challenges and opportunities in planetary health for primary care providers. Lancet Planet Health 2018; 2:e185-e187. [PMID: 29709275 DOI: 10.1016/s2542-5196(18)30055-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Edward Xie
- RFE Building, Toronto General Hospital, Toronto, ON M5G 2C4, Canada.
| | | | | | - Airton Tetelbom Stein
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
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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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Brown LH, Blanchard IE. Sustainable emergency medical service systems: how much energy do we need? Am J Emerg Med 2014; 33:190-6. [PMID: 25488338 DOI: 10.1016/j.ajem.2014.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Modern emergency medical service (EMS) systems are vulnerable to both rising energy prices and potential energy shortages. Ensuring the sustainability of EMS systems requires an empirical understanding of the total energy requirements of EMS operations. This study was undertaken to determine the life cycle energy requirements of US EMS systems. METHODS Input-output-based energy requirement multipliers for the US economy were applied to the annual budgets for a random sample of 19 metropolitan or county-wide EMS systems. Calculated per capita energy requirements of the EMS systems were used to estimate nationwide EMS energy requirements, and the leading energy sinks of the EMS supply chain were determined. RESULTS Total US EMS-related energy requirements are estimated at 30 to 60 petajoules (10(15) J) annually. Direct ("scope 1") energy consumption, primarily in the form of vehicle fuels but also in the form of natural gas and heating oil, accounts for 49% of all EMS-related energy requirements. The energy supply chain-including system electricity consumption ("scope 2") as well as the upstream ("scope 3") energy required to generate and distribute liquid fuels and natural gas-accounts for 18% of EMS energy requirements. Scope 3 energy consumption in the materials supply chain accounts for 33% of EMS energy requirements. Vehicle purchases, leases, maintenance, and repair are the most energy-intense components of the non-energy EMS supply chain (23%), followed by medical supplies and equipment (21%). CONCLUSION Although less energy intense than other aspects of the US healthcare system, ground EMS systems require substantial amounts of energy each year.
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Affiliation(s)
- Lawrence H Brown
- Mt. Isa Centre for Rural and Remote Health, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, QLD, Australia.
| | - Ian E Blanchard
- Alberta Health Services Emergency Medical Services, Calgary, Alberta, Canada; University of Calgary, Department of Community Health Sciences, Alberta, Canada
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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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Brown LH, Buettner PG, Canyon DV. The energy burden and environmental impact of health services. Am J Public Health 2012; 102:e76-82. [PMID: 23078475 DOI: 10.2105/ajph.2012.300776] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We reviewed the English-language literature on the energy burden and environmental impact of health services. METHODS We searched all years of the PubMed, CINAHL, and ScienceDirect databases for publications reporting energy consumption, greenhouse gas emissions, or the environmental impact of health-related activities. We extracted and tabulated data to enable cross-comparisons among different activities and services; where possible, we calculated per patient or per event emissions. RESULTS We identified 38 relevant publications. Per patient or per event, health-related energy consumption and greenhouse gas emissions are quite modest; in the aggregate, however, they are considerable. In England and the United States, health-related emissions account for 3% and 8% of total national emissions, respectively. CONCLUSIONS Although reducing health-related energy consumption and emissions alone will not resolve all of the problems of energy scarcity and climate change, it could make a meaningful contribution.
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Affiliation(s)
- Lawrence H Brown
- Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Townsville, QLD, Australia.
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Yarlagadda S, Webster P, Haworth E. The role of public health in climate change and sustainability: is the UK public health community's response adequate? Perspect Public Health 2012; 132:207-8. [PMID: 22991364 DOI: 10.1177/1757913912457308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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