■数字健康技术(DHT)被推广为减少医疗保健系统对环境的影响的手段。然而,越来越多的文献揭示了数字产业的高污染性质,以及它如何加剧健康不平等。因此,在评估其对医疗保健系统的整体价值时,应考虑DHT的环境足迹。本文的目的是:(1)探讨利益相关者对将DHT的环境影响纳入评估和采购实践的观点;(2)确定促成或限制这种变化实施的因素;(3)鼓励就环境问题如何适应医疗保健系统进行建设性对话,以推动更多DHT。
■在一个大型的加拿大学术医疗中心,对参与DHT的29个利益相关者进行了半结构化访谈。使用源自创新扩散理论的框架,通过混合演绎-归纳过程收集和分析数据。
■在评估和采购中整合DHT的环境影响取决于关键的微观-中观-宏观系统因素,这些因素能够或限制实践和流程的变化。创新(微观)因素包括利益相关者对环境问题的认识以及他们解决DHT对环境的影响的可行程度。组织(中观)因素包括组织的文化,领导力,政策,和实践,以及现有的专业知识和专业技能。最后,外部(宏观)因素包括政治和监管(例如,国家战略,法律,标准,规范),经济(例如,商业模式,公共采购),以及专业和科学因素(例如,证据,方法论,临床指南)。
■考虑到DHT对环境的影响取决于涉及各种利益相关者和治理水平的微观-中观-宏观系统因素,有时会有不同甚至对立的目标和期望。它强调了更好地理解医疗保健环境变化固有的复杂性的重要性。
UNASSIGNED: Digital health technologies (DHTs) are promoted as means to reduce the environmental impact of healthcare systems. However, a growing literature is shedding light on the highly polluting nature of the digital industry and how it exacerbates health inequalities. Thus, the environmental footprint of DHTs should be considered when assessing their overall value to healthcare systems. The objectives of this article are to: (1) explore stakeholders\' perspectives on integrating the environmental impacts of DHTs in assessment and procurement practices; (2) identify the factors enabling or constraining the operationalisation of such a change; and (3) encourage a constructive dialogue on how environmental issues fit within healthcare systems\' push for more DHTs.
UNASSIGNED: Semi-structured interviews were conducted with 29 stakeholders involved in DHTs in a large Canadian academic healthcare centre. Data were collected and analysed through a mixed deductive-inductive process using a framework derived from diffusion of innovations theories.
UNASSIGNED: The integration of the environmental impact of DHTs in assessment and procurement is contingent upon key micro-meso-macrosystemic factors that either enable or constrain changes in practices and processes. Innovation (micro) factors include stakeholders\' recognition of the environmental issue and the extent to which it is feasible for them to address the environmental impact of DHTs. Organisational (meso) factors include the organisation\'s culture, leadership, policies, and practices, as well as the expertise and professional skillsets available. Finally, external (macro) factors include political and regulatory (e.g., national strategy, laws, standards, norms), economic (e.g., business models, public procurement), and professional and scientific factors (e.g., evidence, methodologies, clinical guidelines).
UNASSIGNED: Considering the environmental impact of DHTs depends on micro-meso-macrosystemic factors involving a variety of stakeholders and levels of governance, sometimes with divergent or even antagonistic objectives and expectations. It highlights the importance of better understanding the complexity inherent in the environmental shift in healthcare.