van Bree Egid M, Snijder Lynn E, Ossebaard Hans C, Brakema Evelyn A
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Department of Surgery, Maastricht University, Maastricht, The Netherlands.
J Med Internet Res. 2025 Apr 4;27:e67538. doi: 10.2196/67538.
The health care sector contributes notably to environmental harms, impacting human and ecosystem health. Hence, countries increasingly set ambitions to transition to environmentally sustainable health care, focusing on resource use, energy consumption, and patient travel. Telemedicine is often considered a promising solution to reduce travel-related carbon emissions. However, underlying environmental impact assessments lack important components such as staff travel and fail to adhere to standardized conduct and reporting. Moreover, assessments of telemedicine use in primary care are scarce.
This study aims to quantify and compare the environmental impact of physical visits and telemedicine visits in the context of domiciliary care and home nursing.
We conducted a life cycle assessment following international ISO-14040/44 standards of all resources required per individual patient visit, either in person at the patient's home or via video calling with a dedicated user-friendly tablet. We collected anonymous user data in collaboration with a telemedicine service company, complemented by consulting staff members of four nursing organizations. Telemedicine visits were elementary in nature, such as supporting patients in taking their medication or structuring their daily agenda. We quantified average environmental impacts from cradle to grave, using the Environmental Footprint method, and verified the robustness of the comparison via uncertainty analysis. The variability of environmental impacts in different settings was explored using scenario analyses for the available minimum to maximum ranges.
Compared to a single physical visit in the studied setting, a telemedicine visit contributed less to global warming (0.1 vs 0.3 kg of carbon dioxide equivalents [kgCOeq]; -60%), particulate matter formation (6.2 * 10 vs 1.8 * 10 disease incidence; -60%), and fossil resource use (1.8 vs 4.4 megajoules; -60%). Mineral/metal resource use was higher for telemedicine than for physical visits (1.1 * 10 vs 4.0 * 10 kg antimony equivalent; +180%). Only water use was not consistently different in the uncertainty analysis. Scenario analyses indicated that telemedicine's environmental impact could become similar to physical visits only in urban settings (1-3 km of travel distance) with 50%-100% car commuting (0.1-0.4 vs 0.2-0.7 kgCOeq). In rural settings (5-15 km of travel distance, 80%-100% car commute), physical visits' environmental impact was higher (1.0-3.5 kgCOeq), mostly even for mineral/metal resource use.
Using telemedicine for domiciliary care and home nursing mostly reduces its environmental impact compared to physical visits. Benefits are larger in rural settings, where travel distances between patients are larger, and apply to multiple environmental impacts but not always to mineral/metal resource use. In urban settings, factors that influence the degree to which telemedicine is environmentally beneficial are whether staff are working from home versus at the office, commuting to the office by bicycle versus by car, and reusing video-calling devices. Accordingly, considerate application of telemedicine is important to support care for both human and planetary health.
医疗保健部门对环境危害有显著影响，危及人类和生态系统健康。因此，各国越来越多地设定向环境可持续型医疗保健转型的目标，重点关注资源利用、能源消耗和患者出行。远程医疗通常被认为是减少与出行相关碳排放的一个有前景的解决方案。然而，潜在的环境影响评估缺乏诸如工作人员出行等重要组成部分，并且未能遵循标准化的行为和报告要求。此外，对基层医疗中远程医疗使用情况的评估也很匮乏。
本研究旨在量化并比较上门护理和家庭护理背景下实地就诊和远程医疗就诊的环境影响。
我们按照国际标准化组织（ISO）-14040/44标准，对每位患者每次就诊所需的所有资源进行了生命周期评估，就诊方式要么是亲自到患者家中，要么是通过使用专用的用户友好型平板电脑进行视频通话。我们与一家远程医疗服务公司合作收集了匿名用户数据，并咨询了四个护理组织的工作人员以作补充。远程医疗就诊本质上较为基础，例如帮助患者服药或安排日常日程。我们使用环境足迹方法量化了从摇篮到坟墓的平均环境影响，并通过不确定性分析验证了比较结果的稳健性。我们通过情景分析，针对可用的最小到最大范围，探究了不同环境中环境影响的变异性。
在所研究的环境中，与单次实地就诊相比，远程医疗就诊对全球变暖的影响较小（0.1千克二氧化碳当量[kgCOeq] 对0.3千克；-60%）、颗粒物形成（6.2×10对1.8×10疾病发病率；-60%）以及化石资源使用（1.8兆焦耳对4.4兆焦耳；-60%）。远程医疗的矿物/金属资源使用高于实地就诊（1.1×10对4.0×10千克锑当量；+180%）。在不确定性分析中，只有用水情况没有持续差异。情景分析表明，只有在城市环境（出行距离1 - 3千米）中，当50% - 100%的通勤方式为驾车时，远程医疗的环境影响才可能与实地就诊相似（0.1 - 至0.4千克COeq对0.2 - 0.7千克COeq）。在农村环境（出行距离5 - 15千米，80% - 100%驾车通勤）中，实地就诊的环境影响更高（1.0 - 3.5千克COeq），甚至在矿物/金属资源使用方面大多也是如此。
与实地就诊相比，在上门护理和家庭护理中使用远程医疗大多能降低其环境影响。在农村环境中益处更大，因为患者之间的出行距离更远，并且适用于多种环境影响，但并非总是适用于矿物/金属资源使用。在城市环境中，影响远程医疗环境效益程度的因素包括工作人员是在家工作还是在办公室工作、是骑自行车还是开车通勤到办公室以及视频通话设备的重复使用情况。因此，谨慎应用远程医疗对于支持人类健康和地球健康都很重要。
