DoM awards new grant for innovation and research addressing health system crises

Recent years have seen increasingly greater attention to threats to population health from the climate crisis, worsening social determinants of health for large portions of the population, and the healthcare delivery system buckling under various chronic problems compounded by new stresses from the pandemic.

To support and encourage innovation and research that seeks to address these threats to population health and health systems, the Department of Medicine (DoM) launched its latest Call for Proposals. As leaders, innovators and researchers, the department is committed to engaging in transformational change that addresses the systemic issues and inequities in our healthcare system.

"We hoped this competition would support work with the clear potential to generate concrete impact in the next few years, not just lay the groundwork for more research,” says Dr. Kaveh Shojania, Vice-Chair of Quality & Innovation. “We received applications aiming to address important aspects of health system dysfunction and promote a more preventive approach to major chronic illnesses. These applications all had merit but the review committee ended up awarding the highest scores to two projects related to the climate crisis."

The two projects selected to receive this grant are led by Principal Investigators in the DoM – eAMS-Eco: Climate Conscious Inhaler Prescribing at the Point-of-Care, led by Dr. Samir Gupta, and Growing Sustainable Physicians: A proposal by the CAPE-ON Agrifood Working Group, led by Dr. Valerie Palda.

eAMS-Eco: Climate Conscious Inhaler Prescribing at the Point-of-Care

While people with lung disease are more likely than most to suffer the consequences of climate change because they are sensitive to air pollution and extreme heat, some of the inhalers used to treat lung disease release harmful greenhouse gases (GSGs) that play a part in climate change. For example, the metered-dose inhaler (MDI) is used commonly in the two most prevalent chronic respiratory diseases – asthma and chronic obstructive pulmonary disease (COPD) – and can account for up to 3.5% of health system emissions.

Newer inhalation devices have an overall carbon footprint that is eight to 12 times lower than that of MDIs. Thus, they present an important opportunity to mitigate the climate crisis through healthcare carbon footprint reductions.

Dr. Samir Gupta and his team are seeking to develop decision support and a conversation aid to empower providers and patients to make climate-conscious inhaler selections at the point-of-care, by integrating these with an asthma computerized decision support system - the Electronic Asthma Management System (eAMS).

Dr. Gupta’s 15-month study will aim to build the eAMS-Eco – an enhanced version of the eAMS with embedded cues and a conversation aid to optimize climate-conscious prescribing at the time of guideline-based care optimization, as well as evaluate its impact on inhaler GHGs (including from new inhaler starts and inhaler substitutions), as well as process metrics such as system usability, quality of shared decision making, satisfaction, eco-anxiety, medication costs and system usage.

The primary outcome will be the impact of the intervention on prescribed inhaler GHG emissions (compared between periods through interrupted time series analysis). This unit of measurement will be the average amount of GHGs each patient is expected to produce annually from all prescribed inhalers after their clinical visit.

Dr. Gupta and his team believe that the eAMS can be leveraged to address the climate crisis both indirectly (by optimizing care, which has been shown to reduce unnecessary inhaler use and carbon-intensive healthcare events), and directly (by rendering new/existing inhaler prescription decisions more environmentally friendly), while transforming how care is delivered and optimizing precious health human resources.

“I see patients every day who are more and more worried about the climate crisis – not only its impact on their own health, but also on generations to come,” says Dr. Gupta. “With this project, we hope to empower both providers and patients to make a small change to reduce their carbon footprint by considering their inhaler choice at the point of care. We have high hopes that this technology will not only improve care, but also protect our shared environment.”

Growing Sustainable Physicians: A proposal by the CAPE-ON Agrifood Working Group

Often overlooked, our food system is a central driver of interrelated climate, health and ecological crises, and as such, a significant lever with which to improve both individual and planetary health, address health disparities and ensure the sustainability of our health systems. Agriculture overall, which includes the animal industry but also corn grown for non-food purposes such as ethanol, accounts for approximately 26% of global greenhouse gas emissions, making it second only to the fossil fuel industry.

By bringing together trainee physicians from diverse specialties in a farm setting, Dr. Valerie Palda and her team (CAPE Ontario Agri-food working group) are aiming to increase knowledge of trainees as it relates to climate change, equity, food systems, agriculture and the intersections of these with health. This will be done primarily through the activities of a workshop day taking place in a farm setting. 

The mid-term objectives of the program are to support development of agency, skills and advocacy to engage in climate adaptation and mitigation work. This will be done primarily through the 8-month period after the workshop where learners will be engaged in their program’s pre-existing Quality and Innovation (QI) project, followed by presentation at a capstone event.

A prerequisite for selection in the initial cohort will be an existing QI project requirement and evaluation infrastructure within their program. This will provide the trainee with dedicated time and mentorship support to progress their project. Following the workshop, the participants will continue their collaborative learning for a period of 8 months, meeting multiple times virtually as a group and individually with their QI mentor at their own institution. Repeated meetings over the course of the year will keep them in contact with each other and a final event for presentation will solidify the relationship.

Using process and outcome data collected in the first cycle, the Agrifood group will review and revise the process prior to the second cycle, and new participants will be invited to a second year of farm workshops. Interested participants from the first cycle will become peer leaders in the second cycle of workshops. The long-term objective is to create an ongoing Community of Practice of healthcare providers who are engaged in climate action in the healthcare sector.

Dr. Palda and her team believe that the majority of Ontario healthcare trainees have little connection to or knowledge of the agricultural sector. Equipping physicians with knowledge about the process of growing foods, how this impacts human health, planetary health and equity will make better, more holistically and equity-minded physicians.

“The Lancet has published that climate change will be the biggest global health threat of the 21st century, and also a tremendous opportunity to tackle the social and environmental determinants of health,” says Dr. Palda. “Our project represents an opportunity for interested trainees at multiple sites to develop their knowledge and skills in climate action as it relates to health and healthcare, and become better prepared to lead others to deal with the present and future health impacts we are seeing from climate change.”

Both of these projects involve collaborations with the recently established Collaborative Centre for Climate, Health & Sustainable Care in the Temerty Faculty of Medicine and Dalla Lana School of Public Health, which will help both projects foster a community of practice focused on the intersections of population and planetary health.