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Bonnamy J, Levett-Jones T, Carr B, Lokmic-Tomkins Z, Maguire J, Catling C, Pich J, Fields L, Brand G. Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices: A descriptive survey study. J Adv Nurs 2024. [PMID: 38973250 DOI: 10.1111/jan.16317] [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: 01/31/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/09/2024]
Abstract
AIM To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. DESIGN A cross-sectional survey design. METHODS An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. RESULTS There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively. CONCLUSION Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health. IMPLICATIONS FOR THE PROFESSION All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence. REPORTING METHOD We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- James Bonnamy
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Tracy Levett-Jones
- Health and Climate Initiative, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Bethany Carr
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Zerina Lokmic-Tomkins
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
- Health and Climate Initiative, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Jane Maguire
- School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Christine Catling
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jacqueline Pich
- School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Lorraine Fields
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Gabrielle Brand
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
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Irwin A, Malik A, Vyas A, Bateman C, Joyce S. The carbon footprint of health care delivery in Western Australia's public health system. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101115. [PMID: 39006230 PMCID: PMC11246056 DOI: 10.1016/j.lanwpc.2024.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/06/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024]
Abstract
Background Health systems have a dual imperative to take action on climate change. First, they must develop climate resilient health services in response to the direct and indirect impacts of climate change on health. Second, they must reduce their own carbon footprint since health systems are a significant contributor to global greenhouse gas emissions. Methods An environmentally-extended multi-region input-output analysis was carried out, incorporating National Accounts data for Australia and annual expenditure data from WA Health for financial year 2019-20. Expenditure data were categorised to one of 344 economic sectors and by location of the provider of goods or services purchased. Findings WA Health contributes 8% of WA's total carbon footprint, driven by expenditure on chemicals (23.8% of total), transport (20.2% of total), and electricity supply (19.7% of total). These 3 sectors represent 63.7% of WA Health's carbon footprint, but only 10.8% of its total expenditure. Interpretation Reducing emissions related to health service provision in WA will require a holistic approach that leverages carbon footprinting insights and integrates them into organisational decision-making across all health programs. The high carbon-intensity of the transport and chemicals sectors supports previous research calling for a reduction in unnecessary pathology testing and the transition to delivery of non-urgent health care via sustainable models of telehealth. The impact of WA's size and location presents challenges, with a predominantly non-renewable energy supply and reliance on transport and supply chains from other states adding significantly to emissions. Funding The study received funding from the Australian Research Council, The University of Sydney, and the WA Department of Health. The full list of funding information can be found in Acknowledgements.
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Affiliation(s)
- Amanda Irwin
- The University of Sydney, ISA, School of Physics, Sydney, New South Wales, Australia
| | - Arunima Malik
- The University of Sydney, ISA, School of Physics, Sydney, New South Wales, Australia
- The University of Sydney, Discipline of Accounting, Sydney Business School, Sydney, New South Wales, Australia
- The University of Sydney, The University of Sydney Nano Institute, Faculty of Science, Sydney, New South Wales, Australia
| | - Aditya Vyas
- Healthy Environments and Lives (HEAL) Global Research Centre, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Catherine Bateman
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah Joyce
- Department of Health, Government of Western Australia, Perth, Western Australia, Australia
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Parker G, Hunter S, Born K, Miller FA. Mapping the Environmental Co-Benefits of Reducing Low-Value Care: A Scoping Review and Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:818. [PMID: 39063397 PMCID: PMC11276457 DOI: 10.3390/ijerph21070818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
Reducing low-value care (LVC) and improving healthcare's climate readiness are critical factors for improving the sustainability of health systems. Care practices that have been deemed low or no-value generate carbon emissions, waste and pollution without improving patient or population health. There is nascent, but growing, research and evaluation to inform practice change focused on the environmental co-benefits of reducing LVC. The objective of this study was to develop foundational knowledge of this field through a scoping review and bibliometric analysis. We searched four databases, Medline, Embase, Scopus and CINAHL, and followed established scoping review and bibliometric analysis methodology to collect and analyze the data. A total of 145 publications met the inclusion criteria and were published between 2013 and July 2023, with over 80% published since 2020. Empirical studies comprised 21%, while commentary or opinions comprised 51% of publications. The majority focused on healthcare generally (27%), laboratory testing (14%), and medications (14%). Empirical publications covered a broad range of environmental issues with general and practice-specific 'Greenhouse gas (GHG) emissions', 'waste management' and 'resource use' as most common topics. Reducing practice-specific 'GHG emissions' was the most commonly reported environmental outcome. The bibliometric analysis revealed nine international collaboration networks producing work on eight key healthcare areas. The nineteen 'top' authors were primarily from the US, Australia and Canada.
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Affiliation(s)
| | | | | | - Fiona A. Miller
- Collaborative Centre for Climate, Health & Sustainable Care, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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4
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Dunne B, Cochrane A, Fletcher D. Cutting carbon out of surgical care delivery. ANZ J Surg 2024; 94:984-985. [PMID: 38887980 DOI: 10.1111/ans.19006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Ben Dunne
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Cochrane
- Department of Surgery, Epworth Hospital, Melbourne, Victoria, Australia
- Florey Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - David Fletcher
- Department of Surgery, University of Western Australia, Perth, Western Australia, Australia
- Department of Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
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5
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Moriates C, Silverstein WK, Bandeira de Mello R, Stammen L, Wong BM. High-value care education can learn from the evidence-based medicine movement: moving beyond competencies and curricula to culture. BMJ Evid Based Med 2024; 29:147-150. [PMID: 37479241 DOI: 10.1136/bmjebm-2023-112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Christopher Moriates
- Departments of Internal Medicine and Medical Education, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
- Executive Director, Costs of Care, Boston, Massachusetts, USA
| | - William K Silverstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Choosing Wisely Canada, Toronto, ON, Canada
| | - Renato Bandeira de Mello
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porte Alegre, Brazil
| | - Lorette Stammen
- School of Health Professions Education, Maastricht University, Maastricht, Limburg, Netherlands
| | - Brian M Wong
- Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
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Jønsson ABR. Medicalization of Old Age: Experiencing Healthism and Overdiagnosis in a Nordic Welfare State. Med Anthropol 2024; 43:310-323. [PMID: 38753499 DOI: 10.1080/01459740.2024.2349515] [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: 05/18/2024]
Abstract
In Denmark, people are expected to take responsibility for their health, not least as their bodies age and they experience signs of physical or mental decline. Drawing on fieldwork among older Danes, I illustrate that an excessive focus on health gives rise to social and structural controversies and disparities, linking ideas of healthy behavior at the individual level with the societal framing of disease and aging. I argue that this emphasis contributes to the unwarranted diagnosis of bodily variations that naturally occur in the aging process, a phenomenon referred to as overdiagnosis, adding to a broader medicalization of old age.
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Affiliation(s)
- Alexandra Brandt Ryborg Jønsson
- Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Community Health, The Arctic University of Norway, Tromso, Norway
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7
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Bell KJL, Stancliffe R. Less is more for greener intensive care. Intensive Care Med 2024; 50:746-748. [PMID: 38587554 DOI: 10.1007/s00134-024-07378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Katy J L Bell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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Gabiña IS, José Pita López M. GREEN ICU: responsible and sustainable ICU. Med Intensiva 2024; 48:231-234. [PMID: 38519373 DOI: 10.1016/j.medine.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/28/2023] [Indexed: 03/24/2024]
Affiliation(s)
- Irene Salinas Gabiña
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain; Fisiología Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
| | - M José Pita López
- Servicio de Medicina Preventiva, Hospital Universitario del Henares, Coslada, Madrid, Spain
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Davies JF, McAlister S, Eckelman MJ, McGain F, Seglenieks R, Gutman EN, Groome J, Palipane N, Latoff K, Nielsen D, Sherman JD. Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle analysis. Br J Anaesth 2024:S0007-0912(23)00725-0. [PMID: 38296752 DOI: 10.1016/j.bja.2023.11.053] [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: 09/04/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.v. and oral formulations of paracetamol used in the perioperative period. METHODS Life-cycle assessment of GHG emissions (expressed as carbon dioxide equivalents CO2e) of i.v. and oral paracetamol preparations was performed. Perioperative paracetamol prescribing practices and costs for 26 hospitals in USA, UK, and Australia were retrospectively audited. For those surgical patients for whom oral formulations were indicated, CO2e and costs of actual prescribing practices for i.v. or oral doses were compared with optimal oral prescribing. RESULTS The carbon footprint for a 1 g dose was 38 g CO2e (oral tablet), 151 g CO2e (oral liquid), and 310-628 g CO2e (i.v. dependent on type of packaging and administration supplies). Of the eligible USA patients, 37% received paracetamol (67% was i.v.). Of the eligible UK patients, 85% received paracetamol (80% was i.v.). Of the eligible Australian patients, 66% received paracetamol (70% was i.v.). If the emissions mitigation opportunity from substituting oral tablets for i.v. paracetamol is extrapolated to USA, UK, and Australia elective surgical encounters in 2019, ∼5.7 kt CO2e could have been avoided and would save 98.3% of financial costs. CONCLUSIONS Intravenous paracetamol has 12-fold greater life-cycle carbon emissions than the oral tablet form. Glass vials have higher greenhouse gas emissions than plastic vials. Intravenous administration should be reserved for cases in which oral formulations are not feasible.
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Affiliation(s)
- Jessica F Davies
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Scott McAlister
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew J Eckelman
- Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Forbes McGain
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Sydney School of Public Health, University of Sydney, Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Western Health, Footscray, VIC, Australia
| | - Richard Seglenieks
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Western Health, Footscray, VIC, Australia; Department of Anaesthesia, Grampians Health, Ballarat, VIC, Australia
| | - Elena N Gutman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Groome
- Barts Health NHS Trust, London, UK; Nuffield Health, London, UK
| | - Natasha Palipane
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Katherine Latoff
- Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Dominic Nielsen
- Greener Anaesthesia & Sustainability Project (GASP), London, UK
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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10
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Carrandi A, Nguyen C, Tse WC, Taylor C, McGain F, Thompson K, Hensher M, McAlister S, Higgins AM. How environmental impact is considered in economic evaluations of critical care: a scoping review. Intensive Care Med 2024; 50:36-45. [PMID: 38191675 PMCID: PMC10810918 DOI: 10.1007/s00134-023-07274-7] [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: 08/17/2023] [Accepted: 11/11/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Health care is a major contributor to climate change, and critical care is one of the sector's highest carbon emitters. Health economic evaluations form an important component of critical care and may be useful in identifying economically efficient and environmentally sustainable strategies. The purpose of this scoping review was to synthesise available literature on whether and how environmental impact is considered in health economic evaluations of critical care. METHODS A robust scoping review methodology was used to identify studies reporting on environmental impact in health economic evaluations of critical care. We searched six academic databases to locate health economic evaluations, costing studies and life cycle assessments of critical care from 1993 to present. RESULTS Four studies met the review's inclusion criteria. Of the 278 health economic evaluations of critical care identified, none incorporated environmental impact into their assessments. Most included studies (n = 3/4) were life cycle assessments, and the remaining study was a prospective observational study. Life cycle assessments used a combination of process-based data collection and modelling to incorporate environmental impact into their economic assessments. CONCLUSIONS Health economic evaluations of critical care have not yet incorporated environmental impact into their assessments, and few life cycle assessments exist that are specific to critical care therapies and treatments. Guidelines and standardisation regarding environmental data collection and reporting in health care are needed to support further research in the field. In the meantime, those planning health economic evaluations should include a process-based life cycle assessment to establish key environmental impacts specific to critical care.
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Affiliation(s)
- Alayna Carrandi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
| | - Christina Nguyen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Wai Chung Tse
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Colman Taylor
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia, Western Health, Footscray, VIC, Australia
- Department of Intensive Care, Western Health, Footscray, VIC, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kelly Thompson
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Scott McAlister
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Alisa M Higgins
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia.
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia.
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Pendrey CG, Chanchlani S, Beaton LJ, Madden DL. Planetary health: a new standard for medical education. Med J Aust 2023; 219:512-515. [PMID: 37949607 DOI: 10.5694/mja2.52158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Catherine Ga Pendrey
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
- Climate and Environmental Medicine Specific Interests Group, Royal Australian College of General Practitioners, Melbourne, VIC
| | - Sonia Chanchlani
- Melbourne Medical School, University of Melbourne, Melbourne, VIC
- Doctors for the Environment Australia, Melbourne, VIC
| | - Laura J Beaton
- Melbourne Medical School, University of Melbourne, Melbourne, VIC
- Doctors for the Environment Australia, Melbourne, VIC
| | - Diana L Madden
- University of Notre Dame Australia, Sydney, NSW
- Australasian Faculty of Public Health Medicine, Royal Australasian College of Physicians, Sydney, NSW
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12
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Snow H, Hodgson R, Hii MW, Reeves F, Proud D, Lam T, Gyomber D, Dunne B. Environmentally sustainable surgery: A plea to act. ANZ J Surg 2023; 93:2562-2564. [PMID: 37458184 DOI: 10.1111/ans.18609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Hayden Snow
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Surgery, Western Health, Sunshine, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Russell Hodgson
- Division of Surgery, Northern Health, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Michael W Hii
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of HPB and Upper GI Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Fairleigh Reeves
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - David Proud
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of General Surgery, Austin Health, Melbourne, Australia
| | - Tracey Lam
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Epworth General Surgery Clinical Institute, Epworth HealthCare, Melbourne, Australia
- Department of Surgery, Western Health, Footscray, Australia
| | - Dennis Gyomber
- Division of Surgery, Northern Health, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Benjamin Dunne
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
- Royal Australasian College of Surgeons, Environmental Sustainability in Surgical Practice Working Party, Australia
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13
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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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14
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Davies JF, Ikin B, Francis JJ, McGain F. Implementation approaches to improve environmental sustainability in operating theatres: a systematic review. Br J Anaesth 2023:S0007-0912(23)00253-2. [PMID: 37344341 DOI: 10.1016/j.bja.2023.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
Operating theatres consume large amounts of energy and consumables and produce large amounts of waste. There is an increasing evidence base for reducing the climate impacts of healthcare that could be enacted into routine practice; yet, healthcare-associated emissions increase annually. Implementation science aims to improve the systematic uptake of evidence-based care into practice and could, therefore, assist in addressing the environmental impacts of healthcare. The aim of this systematic search with narrative synthesis was to explore what implementation approaches have been applied to reduce the environmental impact of operating theatre activities, described by implementation phases and methodologies. A search was conducted in EMBASE, PubMed, and CINAHL, limited to English and publication since 2010. In total, 3886 articles were retrieved and 11 were included. All were in the exploratory phase (seven of 11) or initial implementation phase (four of 11), but none were in the installation or full implementation phase. Three studies utilised a recognised implementation theory, model, or framework in the design. Four studies used interprofessional education to influence individuals' behaviour to reduce waste, improve waste segregation, or reduce anaesthetic gases. Of those that utilised behaviour change interventions, all were qualitatively successful in achieving environmental improvement. There was an absence of evidence for sustained effects in the intervention studies and little follow-up from studies that explored barriers to innovation. This review demonstrates a gap between evidence for reducing environmental impacts and uptake of proposed practice changes to deliver low-carbon healthcare. Future research into 'greening' healthcare should use implementation research methods to establish a solid implementation evidence base. SYSTEMATIC REVIEW PROTOCOL: PROSPERO CRD42022342786.
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Affiliation(s)
- Jessica F Davies
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Brigit Ikin
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - Jillian J Francis
- School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Centre for Implementation Research, Ottawa Hospital Research Institute-General Campus, Ottawa, ON, Canada
| | - Forbes McGain
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia, Western Health, Footscray, Victoria, Australia; Department of Intensive Care, Western Health, Footscray, Victoria, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
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15
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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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16
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Hensher M. Climate change, health and sustainable healthcare: The role of health economics. HEALTH ECONOMICS 2023; 32:985-992. [PMID: 36701185 DOI: 10.1002/hec.4656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
Healthcare systems around the world are responding with increasing urgency to rapidly evolving ecological crises, most notably climate change. This Perspective considers how health economics and health economists can best contribute to protecting health and building sustainable healthcare systems in the face of these challenges.
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Affiliation(s)
- Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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17
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Hjörleifsson S, Getz LO. The sustainability of universal health care. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:23-0025. [PMID: 36811428 DOI: 10.4045/tidsskr.23.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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18
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Bein T, McGain F. Climate responsibilities in intensive care medicine-let's go green! An introduction to a new series in Intensive Care Medicine. Intensive Care Med 2023; 49:62-64. [PMID: 36446855 PMCID: PMC9852098 DOI: 10.1007/s00134-022-06930-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Thomas Bein
- Faculty of Medicine, University of Regensburg, 93042, Regensburg, Germany.
| | - Forbes McGain
- Anaesthetist and Intensivist, Western Health, Melbourne, Australia
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19
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Zuccala E, Talley NJ. Health sector leadership is central to the fight against the climate crisis. Med J Aust 2022; 217:480-481. [DOI: 10.5694/mja2.51744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
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20
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Vardoulakis S, Matthews V, Bailie RS, Hu W, Salvador‐Carulla L, Barratt AL, Chu C. Building resilience to Australian flood disasters in the face of climate change. Med J Aust 2022; 217:342-345. [PMID: 35717626 PMCID: PMC9795877 DOI: 10.5694/mja2.51595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Sotiris Vardoulakis
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT,Healthy Environments And Lives (HEAL) National Research NetworkAustralia
| | - Veronica Matthews
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,University Centre for Rural Health, University of SydneyLismoreNSW
| | - Ross S Bailie
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,University of SydneySydneyNSW
| | - Wenbiao Hu
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,Queensland University of TechnologyBrisbaneQLD
| | - Luis Salvador‐Carulla
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,Health Research InstituteUniversity of CanberraCanberraACT
| | - Alexandra L Barratt
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,University of SydneySydneyNSW
| | - Cordia Chu
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,Centre for Environment and Population HealthGriffith UniversityBrisbaneQLD
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21
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Breth-Petersen M, Bell K, Pickles K, McGain F, McAlister S, Barratt A. Health, financial and environmental impacts of unnecessary vitamin D testing: a triple bottom line assessment adapted for healthcare. BMJ Open 2022; 12:e056997. [PMID: 35998953 PMCID: PMC9472108 DOI: 10.1136/bmjopen-2021-056997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To undertake an assessment of the health, financial and environmental impacts of a well-recognised example of low-value care; inappropriate vitamin D testing. DESIGN Combination of systematic literature search, analysis of routinely collected healthcare data and environmental analysis. SETTING Australian healthcare system. PARTICIPANTS Population of Australia. OUTCOME MEASURES We took a sustainability approach, measuring the health, financial and environmental impacts of a specific healthcare activity. Unnecessary vitamin D testing rates were estimated from best available published literature; by definition, these provide no gain in health outcomes (in contrast to appropriate/necessary tests). Australian population-based test numbers and healthcare costs were obtained from Medicare for vitamin D pathology services. Carbon emissions in kg CO2e were estimated using data from our previous study of the carbon footprint of common pathology tests. We distinguished between tests ordered as the primary test and those ordered as an add-on to other tests, as many may be done in conjunction with other tests. We conducted base case (8% being the primary reason for the blood test) and sensitivity (12% primary test) analyses. RESULTS There were a total of 4 457 657 Medicare-funded vitamin D tests in 2020, on average one test for every six Australians, an 11.8% increase from the mean 2018-2019 total. From our literature review, 76.5% of Australia's vitamin D tests provide no net health benefit, equating to 3 410 108 unnecessary tests in 2020. Total costs of unnecessary tests to Medicare amounted to >$A87 000 000. The 2020 carbon footprint of unnecessary vitamin D tests was 28 576 kg (base case) and 42 012 kg (sensitivity) CO2e, equivalent to driving ~160 000-230 000 km in a standard passenger car. CONCLUSIONS Unnecessary vitamin D testing contributes to avoidable CO2e emissions and healthcare costs. While the footprint of this example is relatively small, the potential to realise environmental cobenefits by reducing low-value care more broadly is significant.
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Affiliation(s)
| | - Katy Bell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristen Pickles
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Western Health, Melbourne, Victoria, Australia
| | - Scott McAlister
- Department of Critical Care, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Alexandra Barratt
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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22
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Smith CL, Zurynski Y, Braithwaite J. We can't mitigate what we don't monitor: using informatics to measure and improve healthcare systems' climate impact and environmental footprint. J Am Med Inform Assoc 2022; 29:2168-2173. [PMID: 35822400 DOI: 10.1093/jamia/ocac113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
Climate change, human health, and healthcare systems are inextricably linked. As the climate warms due to greenhouse gas (GHG) emissions, extreme weather events, such as floods, fires, and heatwaves, will drive up demand for healthcare. Delivering healthcare also contributes to climate change, accounting for ∼5% of the global carbon emissions. To rein in healthcare's carbon footprint, clinicians and health policy makers must be able to measure the GHG contributions of healthcare systems and clinical practices. Herein, we scope potential informatics solutions to monitor the carbon footprint of healthcare systems and to support climate-change decision-making for clinicians, and healthcare policy makers. We discuss the importance of methods and tools that can link environmental, economic, and healthcare data, and outline challenges to the sustainability of monitoring efforts. A greater understanding of these connections will only be possible through further development and usage of models and tools that integrate diverse data sources.
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Affiliation(s)
- Carolynn L Smith
- NHRMC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, NSW, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Yvonne Zurynski
- NHRMC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, NSW, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- NHRMC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, NSW, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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