Estimate of the carbon footprint of the US health care sector.
Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA.JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 11/2009; 302(18):1970-2. DOI: 10.1001/jama.2009.1610
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ABSTRACT: Background In 2011 the Australian Government introduced Medicare item numbers for telehealth consultations. This is a rapidly expanding method of health care provision.AimsWe assessed the demographic and disease profile of refugee patients attending a new telehealth clinic, and calculated the patient travel avoided. We examined technical challenges and assessed the performance of two videoconferencing solutions using different bandwidth and latencies.Methods We audited the first 120 patients attending the telehealth clinic. During consultations, the patient was with the general practitioner (GP) and linked by internet videoconference using VIDYO™, GoToMeeting™ or Skype™, to the specialist at a tertiary referral hospital. Travel avoided was calculated and technical problems were assessed by the participating specialist. Bandwidth and latency variations were examined within a university broadband testing facility.ResultsThe two most frequently managed conditions were hepatitis C and latent tuberculosis. Twenty nine different GP's were included and 42 consultations required an interpreter. Nearly 500 km's of travel and 127kg of CO2 production was avoided per consultation. Technical issues were faced in 25% of consultations, most frequently sound problems, and connections dropping out. A bandwidth of at least 512 kbps and latency of no more than 300 milliseconds was necessary to conduct an adequate multipoint videoconference.Conclusions Telehealth using videoconferencing adds a new component to care of refugee and immigrant patients settling in regional areas. Telehealth will be improved by changes to improve simplicity and standardisation of videoconferencing, but requires ongoing Medicare funding to allow sufficient administrative support.Internal Medicine Journal 07/2014; 44(10). DOI:10.1111/imj.12537 · 1.70 Impact Factor
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ABSTRACT: Hospitals are significant contributors to natural resource depletion and environmental change. Our objective was to establish the extent to which hospital environmental sustainability has been studied and the key issues that emerge for policy, practice and research. The PubMed, Engineering Village, Cochrane and King's Fund databases were searched for articles relating to hospital environmental sustainability published in English between 1 January 1990 and 1 October 2013. Further studies were found by review of reference lists. One hundred ninety-three relevant articles were found and 76 were selected for inclusion in the review. Common research themes were identified: hospital design, direct energy consumption, water, procurement, waste, travel and psychology and behaviour. Some countries (particularly the United Kingdom) have begun to invest systematically in understanding the environmental effects of hospitals. We found large variability in the extent of the evidence base according to topic. Research regarding the architectural fabric of hospital buildings is at a relatively mature stage. Similarly, there is a developed research base regarding devices and technologies used within hospitals to reduce the environmental effects of direct hospital energy and water use. Less is known about the clinical, psychological and social factors that influence how health care professionals use resources, travel to/from hospital, and interact with the buildings and technologies available. A significant part of the environmental footprint of hospitals relates to clinical practice, e.g. decisions regarding the use of pharmaceuticals and medical devices. Medical 'cradle to grave' life cycle assessment studies have been published to understand the full financial and environmental costs of hospital activities. The effects of preventive or demand management measures which avoid unnecessary hospital procedures are likely to be much greater than incremental changes to how hospital procedures are performed. There remain significant gaps in the evidence base on hospital sustainability. Assessments of environmental impacts and natural resource use are beginning to be produced, both at the level of individual hospitals and at the health system level. These are an important start, but in many areas do not yet provide sufficiently detailed information to guide decision-making. There are many areas where the interests of patients and the environment coincide, but others where tensions exist. Rising resource costs and climate change mitigation measures are likely to create an increasing stimulus for research on hospital sustainability. Such research will benefit from inter-disciplinary coordination across research funders and countries.Journal of Health Services Research & Policy 05/2014; 19(4). DOI:10.1177/1355819614534836 · 1.73 Impact Factor
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ABSTRACT: Anthropogenic climate change is likely to add significant pressure to the determinants of public health, and to current health and social protection measures in high, middle and low income countries. Adaptation strategies within the health sector are being developed to address the multi-dimensional nature of the costs and impacts. We further develop and apply a new generic conceptual framework for development-compatible climate policy planning to evaluate policy options for middle and low income countries that reduce the adverse health effects of climate change. The criteria used for comparative evaluation included economic, environment, social and institutional factors. The proposed framework, incorporating system dynamics, provides a foundation for a decision-analytical approach to support the formulation of robust climate change adaptation policies to protect human health.Mitigation and Adaptation Strategies for Global Change 03/2014; 19(3):309-330. DOI:10.1007/s11027-014-9544-9 · 2.02 Impact Factor
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