Mapping the environmental co-benefits of reducing low-value care: a scoping review and bibliometric analysis

Abstract

ABSTRACTBackgroundReducing low-value care (LVC) and improving healthcare’s climate readiness are critical factors to improve the sustainability of health systems across the globe. Care practices that have been deemed low or no value, in effect, generate carbon emissions, waste and pollution without improving patient or population health. There is nascent, but growing, research and evaluation to inform practice change focused on the environmental co-benefits of reducing LVC. The objective of this study was to develop foundational knowledge of this field through a scoping review and bibliometric analysis.MethodsWe searched four databases, Medline, Embase, Scopus and CINAHL, each from inception to July 2023. We followed established scoping review and bibliometric analysis methodology to collect and analyze the data. Publication characteristics, healthcare and environmental sustainability focus (scoping review); authors, institutions, institution countries, and collaborations (bibliometric analysis) data were collected.Findings145 publications met inclusion criteria and were published between 2013 – July 2023; with over 80% published since 2020. Empirical studies represented 21% while commentary, editorials or opinions represented 51% of publications. The majority focused on healthcare generally (27%), followed by laboratory testing (14%), and medications (14%). Empirical publications covered a broad range of environmental issues with general and practice-specific ‘Greenhouse gas (GHG) emissions’, ‘waste management’ and ‘resource use’ as most common topics. Reducing practice-specific ‘GHG emissions’ was the most common reported environmental outcome. The bibliometric analysis revealed numerous international collaboration networks of prolific authors producing work across healthcare practices and settings, studying numerous environmental sustainability issues.ConclusionsThis study reveals that research and evaluation to inform practice change on the environmental co-benefits of reducing LVC is growing internationally, across multiple healthcare and environmental areas. Results demonstrate a need and opportunity for the emerging community to clarify approaches and strengthen the evidence-base through further empirical work in the field.