Estimate of the reduced travel and CO2 emissions through utilisation of video software in a remote pharmacist-led outpatient lipid clinic
Authors: Barrett S , Tucker C , Pattman S 
Published: November 2022

Abstract

Introduction
Since the 2008 Climate Change Act, the NHS has a net zero national target.1 Using Pathway Transformation Funding supported by Academic Health Scienced Network North East North Cumbria, a pathway for a pharmacist-led lipid clinic was developed, utilising video software for consultations and a homecare medicines delivery service. The two manufacturers of PCSK9i also have Net Zero carbon policies.

Aim
The objective of this sub-analysis was to estimate number of miles of travel associated with initiation and ongoing treatment with PCSK9i medication for the remote outpatient clinic model compared with traditional face-to-face model. The study did not require ethics approval.

Methods
50 patients from the PCSK9i caseload were reviewed in March 2022. Distance from home to Trust site was determined and travel estimated for the first and subsequent years. An assumption was made that patients travelled from and returned to home address by car. Delivery of medication to the patient’s home was made by a Homecare company and they estimated 4 miles travelled per delivery vs. 12.2miles from patient home to hospital. Patient experience scores for the traditional outpatient model for PCSK9i therapy and the novel pathway utilising remote consultations and homecare delivery of medication were compared. Ethical approval was not required for this service evaluation.

Results
The traditional face-to-face lipid clinic model involved 7 visits to hospital, comprising initial assessment (1 visit) and collection of medication (6 visits) for the first 12 months of therapy. The second and subsequent years of PCSK9i therapy were assumed for 4 visits to hospital for collection of medicines only. For the 50 patients sampled, the mean distance from home to hospital site was 12.2miles (range 0.4-56 miles). Emissions were calculated using an average CO2 emissions per car in the UK as 221.4 grams per mile.2 For each patient, switching to remote consultations and homecare medicines delivery reduced the total year 1 travel from 171 miles of patient car journeys to 24 miles of homecare medicines delivery. Year 2 and subsequent years would similarly reduce from 98 miles to 16 miles for deliveries. Patient experience scores for previous years of the traditional face-to-face model were compared. Based on the limited responses available there was no negative impact on how patients rated the service following changes. Additional questions on the process of booking and joining the virtual consultation were rated as excellent.

Discussion/Conclusion
Over a 5-year period, PCSK9i therapy using a remote clinic with homecare delivery of medicines reduces car journeys by 473 miles per patient and CO2 emissions by 105 kg.2 This is more than the equivalent distance travelling from Newcastle to Cornwall. Although estimates of travel factor in the associated miles of homecare delivery travel, they do not account for patients who would use public transport, thereby overestimating the miles driven by car. This may be balanced in assumptions underestimating the number of variations to the minimum appointment schedule, such as following intolerance for medication. No negative impact was seen on patient experience scores when compared to the traditional face-to-face model.

References
1. NHS England and NHS Improvement. Delivering a ‘Net Zero’ National Health Service. 2020. Available from: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf
2. Department for Business, Energy and Industrial Strategy. Greenhouse gas reporting: conversion factors 2021. 2021. Available from: https://www.gov.uk/government/publications/greenhouse-gas-reporting-conversion-factors-2021