Planetary Health Education and Capacity Building for Healthcare Professionals in a Global Context: Current Opportunities, Gaps and Future Directions

Effective stewardship strategies to enhance appropriateness of refer-out test requests in a Canadian tertiary centre laboratory

OBJECTIVES

Specialized testing conducted in reference laboratories is costly and often not optimally directed. Since 2016, our institution has worked to ensure the appropriateness of refer-out (RO) tests. We examine the impact of utilization initiatives on the patterns of requests and completed tests.

DESIGN AND METHODS

In 2016, 81 RO tests were selected for a more rigorous approval process. Physicians not pre-approved for testing received a prompt to consult with laboratory subject matter experts (SMEs) for further detail. After review, SMEs provided responses, approving or rejecting requests based on clinical relevance. Stewardship activities also included: repatriating tests locally, preferring Canadian over foreign institutions, unbundling tests, distributing educational memos, and introducing staged testing. We collected data on the number of requested (NoR) and number of completed (NoC) tests in 2015, before the implementation of the new vetting procedures, and for the post-implementation phase from 2016-2022.

RESULTS

For 62 targeted RO tests (including trace metals, vitamins, antibodies, and endocrine-related tests), there was a 33% reduction in NoR and a 51% reduction in NoC in 2022 compared to 2015. The total savings for the study period based on NoC was $807,736. The NoC rate for Neuronal antibody tests decreased to 48.6% in 2022, with cost savings of $17,123, and an additional $50,000 saved by changing the testing site. Insourcing apolipoprotein B and fecal calprotectin tests resulted in cost savings of $3,380 and $3,371, respectively, in 2022.

CONCLUSIONS

Automated messaging followed by a formal review of RO test requests is an effective utilization strategy that prevents redundant or clinically unjustified testing. This approach leads to significant economic savings and is expected to improve the efficiency of patient care.

Developing a guide to climate & health justice education: Process and content

Climate justice and health education can address the disproportionate health impacts of climate change on minoritized communities by providing frameworks to build awareness and instigate action on climate-related health inequities. The Envisioning Environmental Equity Educator's Guide to Climate and Health Justice provides a framework for educators, activists and health professionals to lead lessons on health and climate justice that center the experiences of those Most Affected People and Areas (MAPA) by climate change. Collaborators in Brazil, the Philippines, and Uganda engaged in stakeholder meetings to assess priorities and needs about climate and health with policymakers, doctors, activists, and students. These meetings informed the product: An educator's guide to climate and health justice that explores their dynamics from an anti-racist, anti-colonial approach. The guide serves as a recommended lesson framework fit with concepts, examples, and activities for educators teaching in primary and secondary learning settings. It is an innovative climate and health justice educational resource that draws on principles of anti-colonialism, critical thinking and consciousness, and engaged pedagogy. It offers a strategy for climate justice communication that targets diverse audiences across climate, health and social contexts by promoting educational approaches that center MAPA experiences, fit for diverse audiences.

National Planetary Health learning objectives for Germany: A steppingstone for medical education to promote transformative change

Physicians play an important role in adapting to and mitigating the adverse health effects of the unfolding climate and ecological crises. To fully harness this potential, future physicians need to acquire knowledge, values, skills, and leadership attributes to care for patients presenting with environmental change-related conditions and to initiate and propel transformative change in healthcare and other sectors of society including, but not limited to, the decarbonization of healthcare systems, the transition to renewable energies and the transformation of transport and food systems. Despite the potential of Planetary Health Education (PHE) to support medical students in becoming agents of change, best-practice examples of mainstreaming PHE in medical curricula remain scarce both in Germany and internationally. The process of revising and updating the Medical Licensing Regulations and the National Competency-based Catalog of Learning Objectives for Medical Education in Germany provided a window of opportunity to address this implementation challenge. In this article, we describe the development and content of national Planetary Health learning objectives for Germany. We anticipate that the learning objectives will stimulate the development and implementation of innovative Planetary Health teaching, learning and exam formats in medical schools and inform similar initiatives in other health professions. The availability of Planetary Health learning objectives in other countries will provide opportunities for cross-country and interdisciplinary exchange of experiences and validation of content, thus supporting the consolidation of Planetary Health learning objectives and the improvement of PHE for all health professionals globally.