Double Impact: Reducing low-value care – A win-win for patients and the planet: A rapid scoping review

Background: The health care industry is the fifth-largest contributor worldwide to CO2 emissions. Therefore, health systems need to curb CO2 emissions to become environmentally sustainable. We conducted a scoping review to identify literature on (1) the environmental impacts of de-implementation of low-value health care (LVC) and (2) the environmental sustainability of alternative solutions for health care (e.g., devices, medications).
Methods: We searched Ovid MEDLINE® and Scopus (Elsevier) from January 2015 up to 19 June 2023 and consulted experts as additional search strategy. We conducted dual and then single reviewing against a priori defined criteria. One reviewer extracted data, and a second reviewer checked approximately 10% of the data extractions. We used summary statistics to describe the results narratively.
Results: We included 187 articles. Among those, seven studies focussed on de-implementation of LVC (e.g., laboratory tests, diagnostic imaging procedures). The other identified studies examined the following health care practices in relation to their environmental impacts: consultation – travel/telecare (32%), surgical and medical devices (26%), medication (25%), surgical procedures (19%) and diagnostic tests/screening/imaging (13%). Life cycle assessments and other modelling studies were the most applied study designs. Most studies were conducted in Europe (48%), followed by the USA (37%), Australia (9%) and Canada (4%). 75% of the studies were published after 2020. The reported outcomes fell into the following categories: global warming (89%), other negative environmental impact (35%), resource consumption (28%), and chemical hazards (22%).
Conclusion: We identified a steady rise in publications on this topic since 2020. This is indicative of a large and growing scientific interest in environmental sustainability and may be useful as base for further action. De-implementation of LVC seems to be beneficial in two respects: It protects patients from useless or even harmful interventions and can also reduce CO2 emissions of health care.