Online medical visits or telephone appointments can reduce costs, travel and time in the waiting room, but virtual health care may also have environmental benefits, researchers in B.C. and N.S. have found.
With fewer people travelling to medical appointments by car or public transit, some say online or telephone appointments could continue to help reduce greenhouse gas emissions post-pandemic.
"Virtual care has been a priority of people working in this space for a long time," said Dr. Andrea MacNeill, surgical oncologist at Vancouver General Hospital and associate professor in the Department of Surgery at the University of British Columbia.
"We recognize that from an environmental perspective, it's a high-yield area of focus to avoid not only travel emissions, but more emissions-intensive interactions with the health-care system."
A Canadian Medical Association (CMA) survey released last June suggested 47 per cent of Canadians used virtual care such as calls, email, texts or video during the pandemic. Of these, 91 per cent said they were very satisfied with the experience.
Vancouver Coastal Health (VCH) staff wanted to know how some of their patients felt about telemedicine.
After surveying about 100 people who had appointments between April and July of last year in five departments, they found that virtual visits helped patients save time while reducing emissions.
Many of the surveyed patients said they would have driven 15 kilometres or less to get to the appointment.
VCH staff then calculated how much travel emissions were avoided, using the B.C. government's methodology for quantifying greenhouse gas emissions.
"For each avoided in-person appointment that is now a virtual appointment, we ended up avoiding anywhere between two to five kilograms of carbon dioxide equivalent per appointment," said Marianne Dawson, a sustainability consultant with health organizations in the Vancouver area, including VCH.
Dawson said the numbers may seem small but scaled up to include patients across the region, "we can see how quickly those avoided emissions will add up."
Health sector and greenhouse gases
Canada's health sector is among the worst in the world in terms of greenhouse gases, according to a 2019 article in the Canadian Medical Association Journal.
When compared to health-care systems in 47 countries, Canada has the third-highest per capita emissions, according to a post by the Canadian Medical Association.
Creating a greener health-care system is something Dr. Sean Christie and colleagues in Halifax are working on.
"At this point in time, it's probably not front and centre for the majority of people," said Christie, a neurosurgeon and co-lead for a feature project through the Healthy Population Institute at Dalhousie University.
"I think that that's largely because it's not out there that broadly — healthcare has an impact on the environment."
Christie and colleagues are currently collecting data on the carbon footprint of different approaches to patient care, both in-person and virtual, in addition to patient surveys, he said.
He's expecting to see results in late summer.
"A lot of health care, particularly in Canada but worldwide, has been really geared toward cost-effectiveness and care," he said.
"We're not trying to get rid of that, but include in that consideration what is the cost to the environment for our care."
Environmental benefits of telemedicine
Even before the pandemic, studies have shown that telemedicine can reduce greenhouse gas emissions.
A March review of 14 studies on telemedicine and carbon emissions published in the Future Healthcare Journal found the studies "unanimously report that telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions."
The review's authors said the carbon footprint savings ranged between 0.70 to 372 kilograms of carbon dioxide equivalent per appointment.
The review found the carbon footprints of both telephone and video telemedicine were low in comparison to emissions saved from a decrease in travel.
"This could have wide implications in reducing the carbon footprint of healthcare services globally," the reviewers wrote, adding that more research is still needed.
The challenge now, Christie said, is making the environmental benefits of telemedicine more widely known so that it can continue to some degree post-pandemic.
"I don't think that this is front and centre of a lot of patients' minds when confronted with healthcare. But if nobody tells you about a problem, you don't necessarily think about it. So raising awareness, I think, will go a long way," he said.
"If there's a big public demand for something that has a lot of positive impact, then we're going to make hopefully good decisions."