Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Harvard T.H. Chan School of Public Health Center for Climate, Health, and the Global Environment, Boston, MA, USA.
BMC Prim Care. 2024 Nov 22;25(1):399. doi: 10.1186/s12875-024-02622-y.
Frontline clinics - primary care clinics that predominantly serve low-income and socially disadvantaged communities - are facing increasing impacts from climate-related extreme events. This study evaluated staff perspectives at frontline clinics on the health risks of climate change, the impacts of extreme events on their clinics and patients, and their motivators to improve climate resiliency.
A national, cross-sectional survey was conducted of staff working at frontline clinics including administrators, case workers, and providers across the United States. Survey questions assessed clinic and respondent attributes, knowledge of health risks of climate change, preferences for climate change educational and operational resources, and clinic and patient climate impacts and resilience. The survey was distributed electronically to a convenience sample of primary care clinics and to the National Association of Community Health Centers (NACHC) and National Association of Free and Charitable Clinics (NAFC) listservs. Data was collected from September to November of 2021. Respondents were current staff who consented to the survey. Responses were collected via Qualtrics, and the statistical analysis was completed using Stata.
A total of 430 surveys were completed representing clinics in 43 states. Most (82.0%) respondents reported human activities were causing climate change. Over half (52.8%) of respondents reported an operational disruption to their clinic from extreme events in the past 3 years, and another 54.4% had plans in place to address risks from extreme events. The most useful resources identified to improve operational resilience were checklists and planning guidance. Over half (52.0%) of respondents reported they were motivated to use these resources to improve clinic preparedness. Most (84.4%) providers and case workers reported that climate change impacted patient health, however only 36.2% discussed health risks with patients, with barriers including more pressing topics and time available. Another 55.7% of respondents reported they were motivated to learn ways to help patients prepare for extreme events.
Climate-related extreme events were reported to impact patient health and disrupt frontline clinic operations. Overcoming gaps in knowledge about climate change impacts on health and providing climate educational resources can engender motivation to improve clinic and patient resilience to climate change.
基层诊所——主要为低收入和社会弱势群体服务的基层医疗诊所——正日益受到与气候相关的极端事件的影响。本研究评估了基层诊所工作人员对气候变化健康风险、极端事件对其诊所和患者的影响，以及他们提高气候适应力的动机的看法。
对美国基层诊所的工作人员（包括管理人员、个案工作者和服务提供者）进行了一项全国性的、跨部门的调查。调查问题评估了诊所和受访者的特征、对气候变化健康风险的认识、对气候变化教育和运营资源的偏好，以及诊所和患者的气候影响和适应力。该调查以电子方式分发给初级保健诊所的便利样本，以及全国社区卫生中心协会（NACHC）和全国免费和慈善诊所协会（NAFC）的邮件列表。数据收集于 2021 年 9 月至 11 月。同意参与调查的受访者为现任工作人员。调查结果通过 Qualtrics 收集，统计分析使用 Stata 完成。
共完成了来自 43 个州的 430 份调查，代表了 430 家诊所。大多数（82.0%）受访者报告说，人类活动正在导致气候变化。超过一半（52.8%）的受访者报告说，他们的诊所过去 3 年因极端事件而出现运营中断，另有 54.4%的诊所已制定计划以应对极端事件的风险。被认为最有助于提高运营弹性的资源是清单和规划指南。超过一半（52.0%）的受访者表示，他们有动力使用这些资源来提高诊所的准备度。大多数（84.4%）的服务提供者和个案工作者报告说，气候变化影响了患者的健康，但只有 36.2%的人向患者讨论了健康风险，障碍包括更紧迫的话题和可利用的时间。另有 55.7%的受访者表示，他们有动力学习帮助患者为极端事件做准备的方法。
报告称，与气候相关的极端事件影响了患者的健康，并扰乱了基层诊所的运营。克服对气候变化对健康影响的认识差距，并提供气候教育资源，可以激发提高诊所和患者对气候变化适应力的动力。
