The Primary Care Sustainability Working Group was focused on identifying and supporting interventions in primary care that contribute to:
- Climate mitigation through appropriate use of medications (reduction and alternatives). Reducing unnecessary use of metered-dose inhalers was identified as a high impact opportunity for climate mitigation and quality improvement.
- Metered-dose inhalers (MDIs) are common medical devices used to deliver inhaled medication, typically for individuals with asthma or chronic obstructive pulmonary disease (COPD).
- MDIs contain high levels of hydrofluorocarbons (HFCs) that act as potent greenhouse gases (GHGs) when released into the atmosphere, contributing to the healthcare sector’s carbon footprint. Hydrofluorocarbons emissions from Metered-dose inhalers mostly come from the use-phase when propellants are released into the atmosphere.
- Climate resilience by identifying and providing support to people vulnerable to the impacts of climate change.
- Climate change is associated with an increased frequency and severity of severe weather events, the nature of which depends on local weather patterns. In our region, heat waves are one kind of severe weather event that affects health.
- Certain people are more vulnerable to the negative health effects of heat waves. Primary care data may be able to identify these people. Cities and regional municipalities may be positioned to provide services that would protect people from negative health outcomes.
Previous Work
Reducing Unnecessary use of Metered-dose Inhalers
Through continuing professional development and quality improvement, the working group advocated for the following strategies to reduce the carbon impact of inhalers:
- Encourage suitable prescribing practices for inhalers
- Encourage environmentally preferable alternatives to MDIs, such as dry-powder inhalers (DPIs), whenever appropriate
- Facilitate appropriate inhaler technique
- Practice sustainable recovery and recycling of inhalers
The working group sought to facilitate provider awareness about the climate impact of inhalers and to foster understanding of how inhalers can be sustainably prescribed.
Peer-to-Peer Education:
- In 2021, the working group designed and delivered a peer-to-peer educational intervention and generated resources to support practice change.
- With support from CASCADES to engage patient partners and garner feedback from a National Advisory Committee, the resources were refined and adapted into a playbooks:
Local Scan & Needs Assessment:
To better understand whether local academic primary care teams were positioned to use the materials and resources that had been generated, the Working Group conducted discussions with expert stakeholders across the 14 Family Health Teams affiliated with the Toronto Academic Health Science Network. The results were used to generate a scorecard and an overview of key change opportunities and challenges.
Building Climate Resilience for Vulnerable Persons
The working group explored connecting with partners to collaborate on how to protect our vulnerable patients from the negative health consequences of heat waves.
On June 1, 2023, the working group hosted a Heat Vulnerability Roundtable with the aim to:
- Introduce the idea that primary care and community pharmacy can address heat
- Understand heat risk and vulnerabilities: current knowledge and initiatives
- Discuss potential ways for primary care and community pharmacy to address heat risks, and consider what might be needed to achieve those aspirations
For more details on the presentations and discussion, see the event summary and slides. Please find Health Canada’s presentation deck in French here.
Member-led Research:
Dr. Susan Deering is leading a quality improvement project to explore leveraging primary care teams to help patients at risk of heat-related illness acquire municipal or provincial funding for home cooling systems. The intent of this project is to support vulnerable populations to become more resilient to the impacts of heat on their health.
The project aims to identify those patients at high risk of heat related morbidity and mortality, as well as understand the process, barriers, and enablers for patients to receive funding for the installation of cooling devices, after receiving a prescription from their healthcare provider.
Working Groups
Working Group Lead
- Kimberly Wintemute, Family Physician, Department of Family and Community Medicine, Assistant Professor, University of Toronto
Working group members
- Jean Wilson, Assistant Professor, Bloomberg Faculty of Nursing; Primary Health Care Nurse Practitioner
- Lisa Dolovich, Dean, Leslie Dan Faculty of Pharmacy, UT
Panelists
- Samantha Green, Family Physician, Assistant Professor, and Co-Lead in Climate Change and Health, Department of Family and Community Medicine, University of Toronto
- Brenda Chang, Clinical Pharmacy Practitioner, St. Michael’s Hospital Academic Family Health Team
- Gabrielle Busque, BSc, PharmD
Secretariat
- Fiona Miller, Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health; Director, CSHS
- Naba Khan, Research Assistant, CSHS
Working Group Lead
- Kimberly Wintemute, Family Physician, Assistant Professor, Department of Family and Community Medicine, University of Toronto
Working group members
- Samantha Green, Family Physician, Assistant Professor, Department of Family and Community Medicine, University of Toronto
- Karen Cameron, Assistant Professor and Course Coordinator, Leslie Dan Faculty of Pharmacy, University of Toronto
Secretariat
- Fiona Miller, Director, Centre for Sustainable Health Systems, University of Toronto & CASCADES
- Brittany Maguire, Managing Director, Centre for Sustainable Health Systems, University of Toronto
- Aileen Liu, PharmD Candidate; Research Assistant, Centre for Sustainable Health Systems