澳大利亚全科医学采取措施提高环境可持续性，我们能从中得到什么启示？一项定性研究。
What can we learn from Australian general practices taking steps to be more environmentally sustainable? A qualitative study.
机构信息
Speciality of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Sydney North Health Network, Chatswood, NSW, Australia.
出版信息
Fam Pract. 2023 May 31;40(3):465-472. doi: 10.1093/fampra/cmad027.
BACKGROUND
Climate change is impacting the health of individuals worldwide. At the same time, the healthcare sector contributes to carbon emissions. In Australia, healthcare contributes 7% of the country's carbon footprint. Research into the environmental impact and mitigation of carbon emissions in primary care is an emerging area.
OBJECTIVE
To explore staff perspectives on facilitators and barriers to environmental sustainability in 3 Australian general practices seeking to reduce their environmental impact.
METHODS
We used a qualitative, case-study approach, conducting 23 semistructured interviews with staff across the 3 practices including nurses, administrative staff, and doctors. Observation of systems and staff behaviour relating to environmental sustainability was undertaken at 1 practice. Thematic analysis was conducted to determine themes relating to factors influencing the implementation of environmentally sustainable initiatives within practice settings.
RESULTS
Climate mitigation efforts raised by participants were largely focussed on energy and waste reduction, rather than prescribing pharmaceuticals and staff and patient transport. Three main factors influencing change towards sustainable practice were identified: "Leadership," "Staff Engagement and Workplace Culture," and "Concomitant Benefits." A leadership team and workplace culture that valued environmental sustainability were found to be important facilitators, as were concomitant benefits, in particular financial savings. Barriers included what interviewees described as a lack of knowledge about initiatives with the highest impact, lack of understanding described by staff of the evidence behind particular initiatives, waning staff engagement and infection control concerns.
CONCLUSIONS
Our research highlights several important factors that contribute to the implementation of intended environmentally sustainable initiatives in these 3 practices. Further education, research and high-level policy guidance on the potential environmental impact of prescribing pharmaceuticals, staff and patient transport and unnecessary tests and treatments are recommended to further promote environmental sustainability in primary care.
背景
气候变化正在影响全球各地人们的健康。与此同时，医疗保健行业也在排放碳。在澳大利亚，医疗保健行业贡献了该国碳足迹的 7%。对初级保健中碳排放量的环境影响和减排的研究是一个新兴领域。
目的
探索澳大利亚 3 家寻求减少环境影响的全科诊所的员工对环境可持续性的促进因素和障碍的看法。
方法
我们采用定性案例研究方法，对 3 家诊所的员工进行了 23 次半结构化访谈，包括护士、行政人员和医生。在 1 家诊所观察了与环境可持续性相关的系统和员工行为。对主题分析确定了与实践环境中实施环境可持续性举措相关的因素主题。
结果
参与者提出的气候缓解措施主要集中在能源和废物减少上，而不是开处方药以及员工和患者的交通。确定了影响向可持续实践转变的三个主要因素：“领导力”、“员工参与和工作场所文化”和“伴随的利益”。发现重视环境可持续性的领导团队和工作场所文化是重要的促进因素，同时还有伴随的利益，特别是财务节约。障碍包括受访者所描述的对具有最大影响的举措缺乏了解，员工对特定举措背后的证据缺乏理解，员工参与度下降以及感染控制问题。
结论
我们的研究强调了促进这 3 家诊所实施预期环境可持续性举措的几个重要因素。建议进一步开展教育、研究，并为开处方药、员工和患者交通以及不必要的检查和治疗的潜在环境影响提供高层政策指导，以进一步促进初级保健中的环境可持续性。
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