“Greenprint” for Integrated Care Clinics – The Hub and Spoke Model

Background: Climate change is a major public health crisis requiring attention at an individual, local and national policy level. Transport is the largest source of energy related carbon emissions in Ireland (1). The development of integrated care occurs alongside climate emergency. Care previously delivered in hospital outpatients, or a central ‘hub’ is now being delivered in integrated care clinics, “spokes”. We aimed to assess the environmental impact of transport to integrated care clinics compared to travel to hospital clinic. Methods: Geriatric medicine integrated care attendances from January 2023 to March 2023 were included. Distance from the patient’s home address to the location of integrated care clinic (spoke), and to the affiliated hospital (hub) were recorded in kilometres. For the secondary analysis, we considered staff travel to both ‘spoke’ and ‘hub’ clinic, accounting for one doctor and one advanced nurse practitioner (ANP). Where more than one route was available, the shortest distance was recorded. Carbon emissions were estimated based on kilometres travelled by a standard new passenger car (2). Results: Among 206 clinic attendances, the mean distance to ‘spoke’ clinic was 16.06 km (15.98). The mean distance to the ‘hub’ clinic was 39.29 km (17.82). The estimated total distance travelled by patients to integrated care clinics was 3293.45km, whereas the distance which would have been travelled to ‘hub’ clinics was 8055.85km. Total carbon emissions for 3-month travel to ‘spoke’ clinics were estimated at 371kg, compared to 907kg to the ‘hub’. In terms of the secondary analysis, three of the six clinic locations had an ANP living locally whereas only two clinics has co-located doctor. Total staff distance travelled was estimated at 2206.2km to the ‘spoke’ clinic compared to 2911.2km which would have been travelled to the central hospital ‘hub’. Total 3-month distance travelled to the ‘spoke’ clinics (inclusive of staff and patients) was estimated at 5499.65km. Comparatively, the estimated distance travelled by staff and patients the ‘hub’ clinic would have been 10,967.05km. Total reduction in carbon emissions are estimated at 615kg for the three month period. Discussion: Transport is a barrier to healthcare access and interplays with health disparity in rural populations (3). The ‘spoke’ clinics recognise patients as partners in healthcare, promoting ageing in place. The development of integrated care services, which provides necessary care to older adults, may also have an environmental advantage. In this study, less than half the spoke clinic’s staff were living locally. We expect with the expansion of integrated care, healthcare workers would co-locate with community services with further reduction in carbon emissions. Healthcare’s contribution to climate change action is another incentive to invest in integrated care services. References: CO2 emissions [Internet]. 2023. Available from: https://www.seai.ie/data-and-insights/seai-statistics/key- statistics/co2/ Average CO2 emissions from New Passenger Cars, by EU Country [Internet]. Available from: https://www.acea.auto/figure/average-co2-emissions-from-new-passenger-cars-by-eu- country/ Syed ST, Gerber BS, Sharp LK. Traveling towards disease: Transportation Barriers to Health Care Access. Journal of Community Health. 2013;38(5):976–93. doi:10.1007/s10900-013-9681-1