Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
ICES, Ontario, Canada.
JAMA Netw Open. 2022 Oct 3;5(10):e2237545. doi: 10.1001/jamanetworkopen.2022.37545.
IMPORTANCE: There is a growing focus on environmental sustainability in health care. OBJECTIVE: To estimate the environmental and patient-level financial benefits associated with the widespread adoption of virtual care during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study obtained data from linked administrative databases in the universal health care system of Ontario, Canada, from March 2020 to December 2021. Participants included all people with a physician claim for at least 1 episode of virtual care. EXPOSURES: Patients were stratified by age, socioeconomic status quintiles, Charlson Comorbidity Index, and area of residence (rural or urban). MAIN OUTCOMES AND MEASURES: The primary outcomes were total travel distance and estimated travel-related carbon dioxide emissions avoided owing to virtual care visits. Different model assumptions were used to account for electric and hybrid vehicles and public transit use. The secondary outcomes were estimated patient costs (gasoline, parking, or public transit expenses) avoided. RESULTS: During the 22-month study period, 10 146 843 patients (mean [SD] age, 44.1 [23.1] years; 5 536 611 women [54.6%]) had 63 758 914 physician virtual care visits. These visits were associated with avoidance of 3.2 billion km of travel distance and between 545 and 658 million kg of carbon dioxide emissions. Patients avoided an estimated total of $569 to $733 million (Canadian [US $465-$599 million]) in parking, public transit, and gasoline costs. Carbon dioxide emission avoidance and patient cost savings were more apparent in patients living in rural areas, those with higher comorbidity, and those who were older than 65 years. CONCLUSIONS AND RELEVANCE: Results of this study suggest that virtual care was associated with a large amount of carbon dioxide emissions avoided owing to reduced patient travel and with millions of dollars saved in parking, gasoline, or public transit costs. These benefits are likely to continue as virtual care is maintained as part of the health care system.
重要性：医疗保健领域越来越关注环境可持续性。
目的：估计在 COVID-19 大流行期间广泛采用虚拟护理所带来的环境和患者层面的财务效益。
设计、设置和参与者：这项基于人群的横断面研究从加拿大安大略省全民医疗保健系统的相关行政数据库中获取数据，时间范围为 2020 年 3 月至 2021 年 12 月。参与者包括至少有 1 次虚拟护理就诊记录的所有患者。
暴露情况：根据年龄、社会经济状况五分位数、Charlson 合并症指数和居住地区（农村或城市）对患者进行分层。
主要结果和测量指标：主要结果是由于虚拟护理就诊而避免的总旅行距离和估计的与旅行相关的二氧化碳排放量。使用不同的模型假设来考虑电动汽车和混合动力汽车以及公共交通的使用情况。次要结果是估计避免的患者费用（汽油、停车或公共交通费用）。
结果：在 22 个月的研究期间，有 10446843 名患者（平均[标准差]年龄 44.1[23.1]岁；5536611 名女性[54.6%]）接受了 63758914 次医生虚拟护理就诊。这些就诊避免了 32 亿公里的旅行距离和 5.45 亿至 6.58 亿公斤的二氧化碳排放量。患者估计总共避免了 5.69 亿至 7.33 亿美元（加拿大[美国 4.65 亿至 5.99 亿美元]）的停车、公共交通和汽油费用。在农村地区居住的患者、合并症较多的患者以及 65 岁以上的患者中，二氧化碳排放量的避免和患者成本的节约更为明显。
结论和相关性：这项研究的结果表明，由于减少了患者出行，虚拟护理与大量二氧化碳排放量的避免有关，并节省了数百万美元的停车、汽油或公共交通费用。随着虚拟护理作为医疗保健系统的一部分继续存在，这些好处可能会继续存在。
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