Reduce Patient Travel Research Articles

Climate change from the Asia-Pacific perspective: What an allergist needs to know and do.

Allergic diseases such as asthma, atopic dermatitis, and food allergies are a burgeoning health challenge in the Asia-Pacific region. Compounding this, the region has become increasingly susceptible to the impacts of climate change. The region has weathered extreme precipitation, intense heat waves, and dust storms over the recent decades. While the effects of environmental and genetic factors on allergic diseases are well understood, prevailing gaps in understanding the complex interactions between climate change and these factors remain. We aim to provide insights into the various pathways by which climate change influences allergic diseases in the Asia-Pacific population. We outline practical steps that allergists can take to reduce the carbon footprint of their practice on both a systemic and patient-specific level. We recommend that allergists optimize disease control to reduce the resources required for each patient's care, which contributes to reducing greenhouse gas emissions. We encourage the responsible prescription of metered dose inhalers by promoting the switch to dry powder inhalers for certain patients, at each clinician's discretion. We also recommend the utilization of virtual consultations to reduce patient travel while ensuring that evidence-based guidelines for rational allergy management are closely adhered to. Finally, eliminating unnecessary testing and medications will also reduce greenhouse gas emissions in many areas of medical care.

Effectiveness of a Community-Based Ostomy Nursing Technique to Enhance the Delivery of Patient Care and Quality of Life

ABSTRACT This study aimed to develop and validate a community-based ostomy care training program for nursing staff, with the goal of enhancing their ostomy nursing competencies and improving patient satisfaction. Between March 2021 and October 2021, 20 registered nurses and 50 patients with enterostomy surgery who took part in the promotion of a new nursing technique in five community health service centers in the Wuxing District, Huzhou City, were enrolled in this study (forming the intervention group). In addition, 15 registered nurses and 40 patients with enterostomy surgery from four community health service centers with similar economic and health conditions in the same area were randomly selected as the control group. All community health service centers were independent institutions. The indexes before and after the promotion of the technique were compared, and the effectiveness of the training was evaluated by observing the improvement in nursing skills and changes in patient quality of life after the training. The “quality-of-life scale” was used to analyze the quality of life of patients who had undergone colostomy surgery. The new approach to ostomy care delivered in a community setting was found to improve staff knowledge and skill in ostomy care (p < 0.001), improve the quality-of-life scores of patients and reduce patient travel time and medical expenses. The promotion of ostomy nursing techniques in community health service centers has several benefits. It improves the ostomy nursing skill levels of community medical staff. This reduces the occurrence of ostomy complications. Additionally, it establishes an effective connection between tertiary hospitals and community health service centers. This connection is conducive to better nursing care for patients who have undergone ostomy surgery. The hospital – community – family nursing model can improve self-management abilities and reduce the incidence of complications of enterostomies.

#3003 Increased focus on peritoneal dialysis gives patients improved quality of life and saves millions for the region

Abstract Background and Aims Is it possible to improve PD patients' quality of life and everyday life in combination with the challenge of mastering large geographical distances and at the same time a desire to make healthcare more patient safe and enable patients to be co-creators in their dialysis care? With an area of 48,935 km2, which corresponds to 12% of Sweden's area and larger than the whole of Denmark, Östersund Hospital is the only hospital in a region that takes care of 132,670 inhabitants. In 2018, 85% of patients were dialyzed with hemodialysis at Östersund Hospital. Several of the patients had to travel 200-300 km one way, three to four times a week to receive their dialysis treatment. In addition to high medical travel costs for the region, this also contributed to a low quality of life for the patients. Patients of working age found it difficult to maintain their jobs due to long journeys to the hospital. In a study by (Van Bulck et al, 2018), he shows that patients on dialysis have low participation in their care compared to other patient groups. Method A first step towards a change to provide an increased quality of life for the patients was to invest in self-care with peritoneal dialysis. Several studies describe peritoneal dialysis as a treatment with increased freedom that offers the patient independence with the opportunity to continue working if they are of working age (IIkka et al, AJKD 2012). In addition, several studies show several medical benefits, such as preserving the patient's residual function, which indirectly associates with better patient survival (Van de Luijtgaarden et al, NDT 2011). To continue its work, the dialysis clinic needed approval from the region to start using a night machine connected to a cloud service. After a long wait, the dialysis clinic received approval to use the new technology. Results Since the digital platform was introduced, remote dialysis treatment has increased in the Jämtland Härjedalen region. Digitalization gives healthcare professionals the opportunity to follow the patient's treatment results daily and optimize dialysis treatments without the patient needing to visit the hospital. Today, work is more proactive and provides the conditions to prevent problems before they arise. Five years ago, 85% of dialysis treatments were performed at the hospital. Today, as many as 60% of dialysis treatments with peritoneal dialysis take place in the patient's home. Already in the first year of increased self-care, the region saved SEK 6 million on reduced patient travel. Success factors for a successful result and our way of working today: Conclusion With a patient centric approach, a clear goal focuses and collaboration between several different professional categories. Östersund Hospital has managed to increase the proportion of patients with home treatment from 15% to 60%. Through the implementation of new technology in the form of a digital platform tied to a dialysis machine, the patient's treatment can be evaluated and adjusted remotely. From previously working reactively and solving problems when they arise, now working proactively and planning care for the patient. Emergency hospitalizations can be avoided. In addition to reducing the patient's suffering and providing a better quality of life with fewer hospital visits, it also promotes the hospital's finances. By having the courage to dare to try when others say impossible, learn from their mistakes instead of seeing it as a failure, the clinic's work has improved self-care and participation for this patient group.

Healthcare Laboratories: a venture to ramp up health of rural India

Learning outcomes The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis). Case overview/synopsis HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties. Complexity academic level The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas. Supplementary materials Teaching notes are available for educators only. Subject code CSS3: Entrepreneurship.

Dialing for doctors: Secret shopper study of Arizona methadone and buprenorphine providers, 2022

IntroductionMethadone and buprenorphine are effective and safe treatments for opioid use disorder (OUD) and also reduce overdose and all-cause mortality. Identifying and reaching providers of medication for opioid use disorder (MOUD) has proven difficult for prospective patients and researchers. ObjectivesTo assess the accuracy of government-maintained lists of Arizona (AZ) providers prescribing MOUD, and the extent to which these providers are accessible for treatment. MethodsA two-phase study used a listing of 2376 AZ MOUD providers obtained from the U.S. Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration. Phase 1 assessed the accuracy of the listing using internet confirmatory research from May–October 2022. Phase 2 used the resulting list of 838 providers to assess provider availability, type of MOUD treatment provided, and accepted payment through secret shopper calls between November 16 and 30, 2022. ResultsJust over half (52.2 %, n = 1240) of providers were removed from the original listing during Phase 1. One quarter (25.9 %) were no longer in practice. Among the 833 eligible for the secret shopper Phase 2 study, 36.6 % (n = 307) were reached and identified as providing MOUD. A vast majority (88.1 %) of MOUD providers indicating treatment type were accepting new patients, however methadone was identified far more frequently than was likely permitted or provided for OUD. Providers were 5.5 times more likely to accept new patients if they accepted cash payment for services, and 4.9 times more likely if they accepted Medicaid. Rural areas remained underserved. ConclusionsThe active population of MOUD providers is far smaller than surmised. DEA and SAMHSA provider listings are not sufficiently accurate for survey research sampling. Other means of representative sampling will need to be devised, and trusted lists of providers for prospective patients should be promoted, publicly available, and regularly maintained for accuracy. Providers that offer treatment should assure that public-facing staff have basic information about the practice, the treatment offered, and conditions for taking new patients. Concerted efforts must assure rural access at the most local levels to reduce patient travel burden.

Could building more satellite centres reduce the carbon footprint of external beam radiotherapy?

Climate change is increasingly a health emergency. This has been recognised by the NHS which aims to be carbon net zero by 2040. Most of the carbon footprint of radiotherapy is due to patient travel. Here we investigate if satellite centres can help reduce this impact.The carbon footprint of construction was estimated using two different methods. The post codes for 49 patients and 21 staff were collected and the distance to the satellite centre and main centre determined. The carbon footprint from each of these aspects was combined to determine how many years it would take for the reduced patient travel to offset the construction of the satellite centre.The mean carbon footprint of travel to the satellite centre and main centre were 116.0 kgCO2e and 176.2 kgCO2e respectively. The carbon footprint of building the satellite centre was between 1103 tCO2e and 618 tCO2e, meaning it would take 5.6 – 10.0 years to offset the embedded carbon footprint of the new building.For the first time this study has estimated the carbon footprint of building a satellite radiotherapy centre and how this, through reducing patient travel can lower the carbon footprint of the service within a decade. This work may help those wishing to sustainably improve service provision.

338 Wide-Awake Hand Surgery in Trauma: Optimising Patient Experience and Strategies to Advance Patient Care

Abstract Background Our regional hand trauma unit in Greater Manchester underwent significant service reorganisation from predominantly GA to WALANT early in the COVID-19 pandemic. We implemented a variety of strategies to optimise patient care and maintain adherence to national standards. Here, we present a review of these strategies. Method Five domains throughout the patient pathway were explored, with chi-square and student t-testing used to assess significance. Results ‘Time-to-treatment’ compliance with national standards were maintained following reorganisation, with an improvement in compliance for extensor tendon repairs. A pre-operative information leaflet resulted in significant improvements in patient knowledge and anxiety levels. A knowledge-gap in post-operative analgesia administration amongst patients was identified and addressed through a standardised protocol and supplemental written guide to optimally manage peak post-operative pain. Additionally, the shift of our services to our ambulatory unit has resulted in a significant in reduction in our theoretical carbon footprint through reduced patient travel and gaseous anaesthesia use. Conclusions Despite dramatic service reorganisation to a primarily WALANT service, we have demonstrated a multi-faceted approach to optimise the patient journey, whilst upholding compliance with national standards and reducing our overall ecological footprint.

Telemedicine Use Decreases the Carbon Footprint of the Bariatric Surgery Preoperative Evaluation.

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. 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. 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). 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.

The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease.

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. 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. 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). 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.

Rapid triage and transition to telehealth for heart transplant patients in the COVID-19 pandemic setting

Background In the setting of the COVID-19 pandemic, a rapid uptake of telehealth services was instituted with the aim of reducing the spread of disease to vulnerable patient populations including heart transplant recipients. Methods Single-center, cohort study of all heart transplant patients seen by our institution's transplant program during the first 6 weeks of transition from in-person consultation to telehealth (23 March – 5 June 2020). Results Face-to-face consultation allocation strongly favored patients in the early post-operative period (34 vs. 242 weeks post-transplant; p < 0.001). Telehealth consultation dramatically reduced patient travel and wait times (80 min per visit saved in telehealth patients). No apparent excess re-hospitalization or mortality was seen in telehealth patients. Conclusions With appropriate triage, telehealth was feasible in heart transplant recipients, with videoconferencing being the preferred modality. Patients seen face-to-face were those triaged to be higher acuity based on time since transplant and overall clinical status. These patients have the expected higher rates of hospital re-admission, and therefore should continue to be seen in person.

Rendezvous procedure, a simultaneous endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy for choledocholithiasis, in a rural surgical program in Northwest Ontario.

Northwest Ontario has a high prevalence of cholelithiasis, at 1.6 times the provincial norm. There is a concomitant 14% rate of choledocholithiasis. Accessing surgical services in the region often requires extensive travel by air. Choledocholithiasis management is typically with a 2-staged approach, an endoscopic retrograde cholangiopancreatography (ERCP) followed several days or weeks later by laparoscopic cholecystectomy (LC). Regional surgeons were concerned about the patient burden of travel and the loss to follow-up inherent in scheduling two independent procedures at separate hospital admissions. They adopted a 1-stage management, called the rendezvous procedure, which describes the simultaneous performance of an ERCP and LC. We accessed Sioux Lookout Meno Ya Win Health Centre hospital data for all patients receiving an ERCP and LC between 1 June 2019 and 1 December 2022. We documented patient demographics, operative outcomes, length of stay and transfer to other facilities. There were 29 rendezvous procedures performed, with successful cannulation of the ampulla of Vater in 27 (93%) cases and stone removal in 23 (79%), with a complication rate of 7%. The operating time averaged 136 min, and two patients required transfer to a tertiary care centre and four were stented locally and required a return trip to Sioux Lookout for repeat ERCP and successful stone removal. The average length of stay was 2.1 ± 1.3 days. Patients who could not access a rendezvous procedure averaged 46.1 ± 78.1 days between procedures. Managing choledocholithiasis with a 1-stage approach was safe and effective and reduced patient travel, time to definitive care and hospital admissions.

Reduction of patient travel and carbon emissions with virtual visits in general surgery

Background: In response to the COVID-19 pandemic, telemedicine emerged as an important tool. Few studies have examined the impact of virtual visits in General Surgery. The purpose of our study is to analyze the effect of outpatient virtual visits on surgery patient travel burden and its associated environmental impact at a quaternary academic institution. Methods: The electronic medical record was queried for all outpatient visits with 16 general surgery staff comprised of hepato-pancreato-biliary, acute care surgery, hernia and breast at our institution between 2017-2022. Virtual visits were defined as synchronous surgeon-to-patient interaction through video conferencing platform. Telephone encounters were excluded. Office and virtual visits for the 18 months prior to COVID-19 (July 2017- December 2019) were compared to the 18-month period during COVID-19 (January 2020-June 2022). To estimate travel burden and environmental impact, patients were assumed to travel via an average gasoline-powered passenger vehicle. Travel burden of patients was inferred from distance based on zip codes, and travel cost was estimated using distance traveled, parking costs, fuel economy, and average US retail gasoline prices by year. To estimate carbon emissions, the following assumptions were made: 1) average fuel economy is 24.2 miles per gasoline gallon (US Department of Energy); 2) average carbon emissions are 404 grams of CO2 per mile. Results: A total of 56,248 office and distance health visits were identified. In the pre-COVID period, of 26,515 visits, 26,208 (98.8%) were in-office and 307 (1.2%) were virtual visits. During COVID, of 29,733 visits, 26,477 (89.0%) were in-office and 3,256 (10.9%) were virtual visits. Estimated median and total travel burden and environmental impact of virtual visits are summarized in Table 1. Prior to COVID, office visits cost $631,660 in travel, consumed 194,332 gallons of gasoline, and produced 1,899,949 kilograms of CO2 with a median travel distance of 58 (IQR 18-188) miles. Patients undergoing virtual visits during the same period saved a total of $23,942, 8,345 gallons of gasoline, and 81,590 kilograms of CO2 with a median travel distance saved of 378 (IQR 157-785) miles. In the COVID period, office visits cost $592,786 in travel, consumed 174,290 gallons of gasoline, and produced 1,703,999 kilograms of CO2 for a median travel distance of 54 (IQR 18-164) miles. Patients undergoing virtual visits during the same period saved a total of $147,437, 49,233 gallons of gasoline, and 481,341 kilograms of CO2 for travel a median travel distance saved of 182 (IQR 52-404) miles. There is a difference of 40,888 gallons of gasoline and 399,751 kilogram of CO2 for the two periods. Conclusion: Saving nearly 40,000 gallons of gas and over 400,000 kilograms of CO2 emissions, telemedicine was successfully utilized to maintain clinical volume during COVID-19 while reducing patient travel burden, equivalent to carbon sequestered by 473 acres of US forest in one year. The impact of virtual visits extends beyond the cost of care not only in dollars, but on the environment. Further work is needed to measure quality of care and satisfaction of surgeons and patients to continue integration of virtual visits for select general surgery patients.

PP03 Early Assessment Of Video Consultations In Rehabilitation After Hand Injury

IntroductionWith the aim of reducing patient travel and related costs, physiotherapists and occupational therapists at the Oslo University Hospital began offering video consultations to patients with hand and arm injuries in March 2020. A feasibility study was initiated to describe the first year of using video consultations in the rehabilitation of upper extremity injuries in children and adults, and to assess the acceptability of the service from the perspective of hand therapists. The secondary objective of the study was to investigate the economic effects of using video consultation for this patient group.MethodsThe therapists documented the individual consultations in an Excel spreadsheet. Utility and acceptability were analyzed based on the content of each video consultation. The therapists also registered the patient’s municipality in order to calculate costs related to travel, accommodation, and other costs related to in-person consultation. Utility was analyzed using an early economic model based on scenario analysis to compare the costs of video consultations with in-person consultations.ResultsBased on the content analysis from 89 consultations, video consultations were deemed acceptable by the therapists. The total travel distance from patients’ homes to the hospital was 20,190 km, as hand rehabilitation is a national service. The video consultations that replaced the consultations at the hospital were potentially more time efficient, reduced patients’ travel time and absence from home and work, and saved costs for the Oslo University Hospital and society.ConclusionsBased on early decision support provided by this study, adaptions were made to the delivery of video consultations to improve the cost effectiveness of the service. The findings from this study provided an indication of the potential value of the new service, which may be used for benchmarking purposes to ensure that it meets the needs of users, the health service, and society.

Association of Virtual Care Expansion With Environmental Sustainability and Reduced Patient Costs During the COVID-19 Pandemic in Ontario, Canada

There is a growing focus on environmental sustainability in health care. To estimate the environmental and patient-level financial benefits associated with the widespread adoption of virtual care during the COVID-19 pandemic. 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. Patients were stratified by age, socioeconomic status quintiles, Charlson Comorbidity Index, and area of residence (rural or urban). 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. 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. 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.

Telehealth: Reducing Patients' Greenhouse Gas Emissions at One Academic Psychiatry Department.

ObjectiveAcademic and organizational leaders in psychiatry and all other medical fields are negatively impacted by climate change. The COVID-19 pandemic prompted a rapid shift to the use of more telehealth by behavioral health clinicians. The purpose of this study was to estimate the reduction of patients’ greenhouse gas emissions during this rapid shift at one academic psychiatry institution.MethodsThe authors extracted data associated with all outpatient visits to all 26 psychiatry clinics from March 16, 2020, to December 31, 2020. Once the patients’ travel miles saved by confirmed virtual visits were calculated, the authors used the standard ratio from the US Environmental Protection Agency (EPA) to calculate the total quantity of CO2 that would be emitted if the visits had occurred in person.ResultsDuring the study period, a total of 47,582 outpatient behavioral health visits with 3975 unique patients were completed. The majority of these departmental visits were telehealth (85%), with most of the telehealth visits conducted using real-time audio-video platforms (75.7%). Subtracting emissions from patient technology during telehealth visits from the estimated patient transport values produced a net savings of greenhouse gas emissions of 867,011 kg CO2. This amount is equal to the greenhouse gas emissions from 189 passenger vehicles driven for 1 year according to the EPA.ConclusionsThis study shows that converting in person, face-to-face behavioral health visits to telehealth has the potential to increase both energy efficiency and conservation through a reduction in greenhouse gas emissions due to reduced patient travel. If these values were extrapolated to the total adult US population who have visits for behavioral health reasons, we estimate that conversion to virtual visits could save approximately 830,000 metric tons of CO2 annually. Organizational leaders should consider these societal benefits when making decisions regarding development and support of telehealth.

The Road Less Traveled: Transportation Barriers to Cancer Care Delivery in the Rural Patient Population.

Patients with cancer residing in geographically rural areas experience lower rates of preventative screening, more advanced disease at presentation, and higher mortality rates compared with urban populations. Although multiple factors contribute, access to transportation has been proposed as a critical barrier affecting timeliness and quality of health care delivery in rural populations. Patients from geographically rural regions may face a variety of transportation barriers, including lack of public transportation, limited access to private vehicles, and increased travel distance to specialized oncologic care. A search using PubMed was conducted to identify articles pertaining to transportation barriers to cancer care and tested interventions in rural patient populations. Studies demonstrate that transportation barriers are associated with delayed follow-up after abnormal screening test results, decreased access to specialized oncology care, and lower rates of receipt of guideline-concordant treatment. Low clinical trial enrollment and variability in survivorship care are also linked to transportation barriers in rural patient populations. Given the demonstrated impact of transportation access on equitable cancer care delivery, several interventions have been tested. Telehealth visits and outreach clinics appear to reduce patient travel burden and increase access to specialized care, and patient navigation programs are effective in connecting patients with local resources, such as free or subsidized nonemergency medical transportation. To ensure equal access to high-quality cancer care and reduce geographic disparities, the design and implementation of tailored, multilevel interventions to address transportation barriers affecting rural communities is critical.

Improving Access to Cancer Treatment Services in Australia's Northern Territory-History and Progress.

Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.

Perspectives on Telehealth for older adults during the COVID-19 pandemic using the quadruple aim: interviews with 48 physicians

BackgroundTelehealth delivery expanded quickly during the COVID-19 pandemic after the reduction of payment and regulatory barriers, but older adults are the least likely to benefit from this expansion. Little is known about physician experiences initiating telehealth and factors that fostered or discouraged adoption during the COVID-19 pandemic with older adult patients. Therefore, our objective was to understand experiences of frontline physicians caring for older adults via telehealth during the COVID-19 pandemic.MethodsWe conducted semi-structured interviews from September 2020 to November 2020 with 48 physicians. We recruited a diverse sample of geriatricians (n = 18), primary care (n = 15), and emergency (n = 15) physicians from all United Stated (US) regions, rural-urban settings, and academic-community practices who cared for older adult patients during the pandemic using purposive sampling methods. We completed framework analysis of the transcribed interviews to identify emerging themes and used the Quadruple Aim to organize themes.ResultsFrontline physicians described telehealth as a more flexible, value-based, and patient-centered mode of health care delivery. Benefits of using telehealth to treat older adults included reducing deferred care and increasing timely care, improving efficiency for physicians, enhancing communication with caregivers and patients, reducing patient travel burdens, and facilitating health outreach and education. Challenges included unequal access for rural, older, or cognitively impaired patients. Physicians noted that payment parity with in-person visits, between video and telephone visits, and relaxation of restrictive regulations would enhance their ability to continue to offer telehealth.ConclusionsFrontline physicians who treated older adults during the COVID-19 pandemic were largely in favor of continuing telehealth use beyond the pandemic; however, they noted that sustainability would depend on enacting policies that address access inequities and reimbursement concerns. Our data provide policy insights that if placed into action could facilitate the long-term success of telehealth and encourage a more flexible healthcare delivery system in the US.

Reshaping wound care: Evaluation of an artificial intelligence app to improve wound assessment and management amid the COVID-19 pandemic.

Wound documentation is integral to effective wound care, health data coding and facilitating continuity of care. This study evaluated the usability and effectiveness of an artificial intelligence application for wound assessment and management from a clinician‐and‐patient user perspective. A quasi‐experimental design was conducted in four settings in an Australian health service. Data were collected from patients in the standard group (n = 166, 243 wounds) and intervention group (n = 124, 184 wounds), at baseline and post‐intervention. Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively, and bivariate statistics were used to determine between‐group differences. Thematic analysis of interviews was conducted. Compared with the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% vs 70%, P < .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99%). Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. The use of the application facilitated remote patient monitoring and reduced patient travel time while maintaining optimal wound care.

170 Social and Environmental Benefits of Virtual Fracture Clinics in Trauma and Orthopaedic Surgery: Reduced Patient Travel Time, Patient Cost and Air Pollutant Emissions

AimSeveral papers have analysed the clinical benefits and safety of Virtual Fracture Clinics (VFCs). A significant increase in the use of Trauma and Orthopaedic (T&O) VFCs was seen during the COVID-19 pandemic. This study aims to investigate the social impact of VFCs on the travel burden and travel costs of T&O patients, as well as the potential environmental benefits in relation to fuel consumption and travel-related pollutant emissions.MethodAll patients referred for T&O VFC review from March 2020 to June 2020 were retrospectively analysed. The travel burden and environmental impacts of hypothetical face-to-face consultations were compared with these VFC reviews. The primary outcomes measured were patient travel time saved, patient travel distance saved, patient cost savings and reduction in air-pollutant emissions.ResultsOver a four-month period, 1359 VFC consultations were conducted. The average travel distance saved by VFC review was 88.6 kilometres (range 3.3-615), with an average of 73 minutes (range 9-390) of travel-time saved. Patients consumed, on average, 8.2 litres (range 0.3-57.8) less fuel and saved an average of €11.02 (range 0.41-76.59). The average reduction in air-pollutant vehicle emissions, including carbon dioxide, carbon monoxide, nitric oxides and volatile organic compounds was 20.3 kilograms (range 0.8-140.8), 517.3 grams (g) (range 19.3-3592.3), 38.1g (range 1.4-264.8) and 56.9g (range 2.1-395.2), respectively.ConclusionsVFCs reduce patient travel distance, travel time and travel costs. In addition, VFCs confer significant environmental benefits through reduced fuel consumption and reduction of harmful environmental emissions.