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  • Journal article
    Espinosa-González AB, Delaney BC, Marti J, Darzi Aet al., 2021,

    The role of the state in financing and regulating primary care in Europe: a taxonomy

    , Health Policy, Vol: 125, Pages: 168-176, ISSN: 0168-8510

    Traditional health systems typologies were based on health system financing type, such as the well-known OECD typology. However, the number of dimensions captured in classifications increased to reflect health systems complexity. This study aims to develop a taxonomy of primary care (PC) systems based on the actors involved (state, societal and private) and mechanisms used in governance, financing and regulation, which conceptually represents the degree of decentralisation of functions. We use nonlinear canonical correlations analysis and agglomerative hierarchical clustering on data obtained from the European Observatory on Health Systems and Policy and informants from 24 WHO European Region countries. We obtain four clusters: 1) Bosnia Herzegovina, Czech Republic, Germany, Slovakia and Switzerland: corporatist and/or fragmented PC system, with state involvement in PC supply regulation, without gatekeeping; 2) Greece, Ireland, Israel, Malta, Sweden, and Ukraine: public and (re)centralised PC financing and regulation with private involvement, without gatekeeping; 3) Finland, Norway, Spain and United Kingdom: public financing and devolved regulation and organisation of PC, with gatekeeping; and 4) Bulgaria, Croatia, France, North Macedonia, Poland, Romania, Serbia, Slovenia and Turkey: public and deconcentrated with professional involvement in supply regulation, and gatekeeping. This taxonomy can serve as a framework for performance comparisons and a means to analyse the effect that different actors and levels of devolution or fragmentation of PC delivery may have in health outcomes.
  • Journal article
    Aufegger L, Yanar C, Bicknell C, Darzi Aet al., 2021,

    The risk-value trade-off: price and brand information impact consumers’ intentions to purchase OTC drugs

    , Journal of Pharmaceutical Policy and Practice, Vol: 14, ISSN: 2052-3211

    BackgroundEuropean countries face fiscal pressure regarding the long-term sustainability of their healthcare system due to increasing levels of public health expenditures and mounting demographic pressures. The promotion of generic drugs is considered to be an efficient means to tackle these challenges; however, market diffusion remains slow. The aim of this study was to investigate the impact of price and brand cues on purchase intentions by means of Direct-to-Consumer (DTC) advertising, and to build on the market cue evaluation model by Dodd et al.MethodsParticipants rated purchase intentions on six DTC adverts varying in price and brand information, followed by self-reports on purchase intentions, attitudes towards generics, brand loyalty, price consciousness, as well as perceptions of quality, risk and value. Open-ended questions explored attitudes toward generic drugs.ResultsBrand information and purchase intentions were mediated by perceived risk and perceived quality, while price information influenced purchase intention through perceptions of quality, risk and value. Consumers’ purchase behaviour was furthermore influenced by unawareness and misconceptions, past experiences, and advertising as a decision-making tool.ConclusionsAdvertisements, including price and brand information, are an important tool to improve consumers’ awareness of the availability of different OTC drugs. Practical and theoretical implications are discussed.
  • Journal article
    Viner RM, Bonell C, Drake L, Jourdan D, Davies N, Baltag V, Jerrim J, Proimos J, Darzi Aet al., 2021,

    Reopening schools during the COVID-19 pandemic: governments must balance the uncertainty and risks of reopening schools against the clear harms associated with prolonged closure

    , Archives of Disease in Childhood, Vol: 106, Pages: 111-113, ISSN: 0003-9888
  • Journal article
    Dewa L, Crandell C, Choong E, Jaques J, Bottle R, Kilkenny C, Lawrence-Jones A, Di Simplicio M, Nicholls D, Aylin Pet al., 2020,

    CCopeY: a mixed-methods co-produced study on the mental health status and coping strategies of young people during COVID-19 UK lockdown

    , Journal of Adolescent Health, ISSN: 1054-139X

    PurposeExploring the impact of COVID-19 pandemic on young people’s mental health is an increasing priority. Studies to date are largely surveys and lack meaningful involvement from service users in their design, planning and delivery. The study aimed to examine the mental health status and coping strategies of young people during the first UK COVID-19 lockdown using co-production methodology.MethodsThe mental health status of young people (aged 16-24) in April 2020 was established utilising a sequential explanatory co-produced mixed methods design. Factors associated with poor mental health status including coping strategies were also examined using an online survey and semi-structured interviews.Results30.3% had poor mental health and 10.8% had self-harmed since lockdown. Young people identifying as Black/Black-British ethnicity had the highest increased odds of experiencing poor mental health (odds ratio [OR] 3.688, 95% CI 0.54-25.40). Behavioural disengagement (OR 1.462, 95% CI 1.22-1.76), self-blame (OR 1.307 95% CI 1.10-1.55), and substance use (OR 1.211 95% CI 1.02-1.44) coping strategies, negative affect (OR 1.109, 95% CI 1.07-1.15), sleep problems (OR 0.915 95% CI 0.88-0.95) and conscientiousness personality trait (OR 0.819 95% CI 0.69-0.98) were significantly associated with poor mental health. Three qualitative themes were identified: (1) pre-existing/developed helpful coping strategies employed, (2) mental health difficulties worsened and (3) mental health and non-mental health support needed during and after lockdown.ConclusionPoor mental health is associated with dysfunctional coping strategies. Innovative coping strategies can help other young people cope during and after lockdowns, with digital and school promotion and application.
  • Journal article
    Iqbal F, Lam K, Joshi M, Khan S, Ashrafian H, Darzi Aet al., 2021,

    Clinical outcomes of digital sensor alerting systems in remote monitoring: a systematic review and meta-analysis

    , npj Digital Medicine, Vol: 4, Pages: 1-12, ISSN: 2398-6352

    Advances in digital technologies have allowed remote monitoring and digital alerting systems to gain popularity. Despite this, limited evidence exists to substantiate claims that digital alerting can improve clinical outcomes. The aim of this study was to appraise the evidence on the clinical outcomes of digital alerting systems in remote monitoring through a systematic review and meta-analysis. A systematic literature search, with no language restrictions, was performed to identify studies evaluating healthcare outcomes of digital sensor alerting systems used in remote monitoring across all (medical and surgical) cohorts. The primary outcome was hospitalisation; secondary outcomes included hospital length of stay (LOS), mortality, emergency department and outpatient visits. Standard, pooled hazard ratio and proportion of means meta-analyses were performed. A total of 33 studies met the eligibility criteria; of which, 23 allowed for a meta-analysis. A 9.6% mean decrease in hospitalisation favouring digital alerting systems from a pooled random effects analysis was noted. However, pooled weighted mean differences and hazard ratios did not reproduce this finding. Digital alerting reduced hospital LOS by a mean difference of 1.043 days. A 3% mean decrease in all-cause mortality from digital alerting systems was noted. There was no benefit of digital alerting with respect to emergency department or outpatient visits. Digital alerts can considerably reduce hospitalisation and length of stay for certain cohorts in remote monitoring. Further research is required to confirm these findings and trial different alerting protocols to understand optimal alerting to guide future widespread implementation.
  • Journal article
    Nurek M, Rayner C, Freyer A, Taylor S, Järte L, MacDermott N, Delaney BCet al., 2021,

    Recommendations for the Recognition, Diagnosis, and Management of Patients with Post COVID-19 Condition ('Long COVID'): A Delphi Study

    , SSRN Electronic Journal
  • Journal article
    Smalley K, Aufegger L, Flott K, Mayer E, Darzi Aet al., 2021,

    Can self-management programmes change healthcare utilisation in COPD?: A systematic review and framework analysis

    , Patient Education and Counseling, Vol: 104, Pages: 50-63, ISSN: 0738-3991

    ObjectiveThe study aims to evaluate the ability of self-management programmes to change the healthcare-seeking behaviours of people with Chronic Obstructive Pulmonary Disease (COPD), and any associations between programme design and outcomes.MethodsA systematic search of the literature returned randomised controlled trials of SMPs for COPD. Change in healthcare utilisation was the primary outcome measure. Programme design was analysed using the Theoretical Domains Framework (TDF).ResultsA total of 26 papers described 19 SMPs. The most common utilisation outcome was hospitalisation (n = 22). Of these, 5 showed a significant decrease. Two theoretical domains were evidenced in all programmes: skills and behavioural regulation. All programmes evidenced at least 5 domains. However, there was no clear association between TDF domains and utilisation. Overall, study quality was moderate to poor.ConclusionThis review highlights the need for more alignment in the goals, design, and evaluation of SMPs. Specifically, the TDF could be used to guide programme design and evaluation in future.Practice implicationsPractices have a reasonable expectation that interventions they adopt will provide patient benefit and value for money. Better design and reporting of SMP trials would address their ability to do so.
  • Journal article
    O'Brien N, Grass E, Martin G, Durkin M, Darzi A, Ghafur Set al., 2021,

    Developing a globally applicable cybersecurity framework for healthcare: a Delphi consensus study

    , BMJ INNOVATIONS, Vol: 7, Pages: 199-207, ISSN: 2055-8074
  • Journal article
    Jones MD, McGrogan A, Raynor DK, Watson MC, Franklin BDet al., 2021,

    User-testing guidelines to improve the safety of intravenous medicines administration: a randomised in situ simulation study

    , BMJ QUALITY & SAFETY, Vol: 30, Pages: 17-26, ISSN: 2044-5415
  • Conference paper
    Hu M, Kassanos P, Keshavarz M, Yeatman E, Lo Bet al., 2021,

    Electrical and Mechanical Characterization of Carbon-Based Elastomeric Composites for Printed Sensors and Electronics

    , International Conference on Flexible and Printable Sensors and Systems (FLEPS), Publisher: IEEE

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