Environmental Impact of Physical Visits and Telemedicine in Nursing Care at Home: Comparative Life Cycle Assessment.

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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 [kgCO₂eq]; -60%), particulate matter formation (6.2 * 10^-9 vs 1.8 * 10^-8 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^-5 vs 4.0 * 10^-6 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 kgCO₂eq). In rural settings (5-15 km of travel distance, 80%-100% car commute), physical visits' environmental impact was higher (1.0-3.5 kgCO₂eq), mostly even for mineral/metal resource use.

Conclusions: 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.