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  • Journal article
    Danielli S, Patria R, Donnelly P, Ashrafian H, Darzi Aet al., 2021,

    Economic interventions to ameliorate the impact of COVID-19 on the economy and health: an international comparison

    , Journal of Public Health, Vol: 43, Pages: 42-46, ISSN: 1741-3842

    BackgroundThe COVID-19 pandemic continues to challenge governments and policymakers worldwide. They have rightfully prioritised reducing the spread of the virus through social distancing interventions. However, shuttered business and widespread restrictions on travel and mobility have led to an economic collapse with increasing uncertainty of how quickly recovery will be achieved.MethodsThe authors carried out a review of publicly available information on the economic intervention’s countries have put in place to ameliorate the impact of COVID-19.ResultsThe strategies and scale of economic interventions have been broad, ranging from 2.5% to a reported 50% of Gross Domestic Product.ConclusionsNumerous countries are beginning to ease lockdown restrictions and restart economies in different ways. There is therefore evolving, real-world data that should be used dynamically by governments and policymakers. The strategies on restarting the economy must be balanced against the uncertainty of a possible second wave of COVID-19. A nuanced approach to easing restrictions needs to take into account not only immediate risk to life but longer-term risks of widening inequalities and falling life expectancy.

  • Journal article
    Freise L, Neves AL, Flott K, Harrison P, Kelly J, Darzi A, Mayer EKet al., 2021,

    Assessment of patients' ability to review electronic health record information to identify potential errors: cross-sectional web-based survey

    , JMIR Formative Research, Vol: 5, ISSN: 2561-326X

    Background: Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs.Objective: The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized.Methods: A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes.Results: A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the res

  • Journal article
    Olivia L, Roberts L, Jonathan R G, Pip B, Lenny N, Kelsey M F, Anna L-J, Saira G, Ara D, Neves ALet al., 2021,

    “Opening a Can of Worms” - exploring public hopes and fears on healthcare data sharing: qualitative study

    , Journal of Medical Internet Research, Vol: 23, ISSN: 1438-8871

    Background: Evidence suggests that health care data sharing may strengthen care coordination, improve quality and safety, and reduce costs. However, to achieve efficient and meaningful adoption of health care data-sharing initiatives, it is necessary to engage all stakeholders, from health care professionals to patients. Although previous work has assessed health care professionals’ perceptions of data sharing, perspectives of the general public and particularly of seldom heard groups have yet to be fully assessed.Objective: This study aims to explore the views of the public, particularly their hopes and concerns, around health care data sharing.Methods: An original, immersive public engagement interactive experience was developed—The Can of Worms installation—in which participants were prompted to reflect about data sharing through listening to individual stories around health care data sharing. A multidisciplinary team with expertise in research, public involvement, and human-centered design developed this concept. The installation took place in three separate events between November 2018 and November 2019. A combination of convenience and snowball sampling was used in this study. Participants were asked to fill self-administered feedback cards and to describe their hopes and fears about the meaningful use of data in health care. The transcripts were compiled verbatim and systematically reviewed by four independent reviewers using the thematic analysis method to identify emerging themes.Results: Our approach exemplifies the potential of using interdisciplinary expertise in research, public involvement, and human-centered design to tell stories, collect perspectives, and spark conversations around complex topics in participatory digital medicine. A total of 352 qualitative feedback cards were collected, each reflecting participants’ hopes and fears for health care data sharing. Thematic analyses identified six themes under hopes: enablement

  • Journal article
    Obrien N, Flott K, Durkin M, 2021,

    COVID-19: leadership on the frontline is what matters when we support healthcare workers.

    , Int J Qual Health Care, Vol: 33

    The implications of severe acute respiratory syndrome coronavirus (SARS-CoV-2, henceforth described as COVID-19) on healthcare systems globally are proving to be immense, with unforeseen impacts that are still to fully emerge. Local and national healthcare systems, hospitals and healthcare workers have been overwhelmed by the needs of patients and limited by weaknesses in resources, staff capacity and distribution networks. These circumstances impact the ergonomic conditions within which healthcare staff work and subsequently their behavioural responses.In this commentary, we argue that urgent research is needed globally to bridge the evidence gap that exists on how best to support healthcare workers with the repercussions of working on the frontline of a pandemic. Leadership on the frontline is what matters. It is not only what policies, guidelines and checklists are in place to support nurses, doctors and healthcare workers, it is the actions and behaviours of their frontline and local leaders in implementing initiatives that really make the difference.Recognizing that the leadership style, organizational culture and model of successful implementation are inextricable is the first step to ensure sustainable interventions to support healthcare workers' well-being will follow.

  • Journal article
    Ward H, Atchison C, Whitaker M, Ainslie KEC, Elliott J, Okell L, Redd R, Ashby D, Donnelly C, Barclay W, Darzi A, Cooke G, Riley S, Elliott Pet al., 2021,

    SARS-CoV-2 antibody prevalence in England following the first peak of the pandemic.

    , Nature Communications, Vol: 12, Pages: 1-8, ISSN: 2041-1723

    England has experienced a large outbreak of SARS-CoV-2, disproportionately affecting people from disadvantaged and ethnic minority communities. It is unclear how much of this excess is due to differences in exposure associated with structural inequalities. Here we report from the REal-time Assessment of Community Transmission-2 (REACT-2) national study of over 100,000 people. After adjusting for test characteristics and re-weighting to the population, overall antibody prevalence is 6.0% (95% CI: 5.8-6.1). An estimated 3.4 million people had developed antibodies to SARS-CoV-2 by mid-July 2020. Prevalence is two- to three-fold higher among health and care workers compared with non-essential workers, and in people of Black or South Asian than white ethnicity, while age- and sex-specific infection fatality ratios are similar across ethnicities. Our results indicate that higher hospitalisation and mortality from COVID-19 in minority ethnic groups may reflect higher rates of infection rather than differential experience of disease or care.

  • 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
    Dewa L, Crandell C, Choong E, Jaques J, Bottle R, Kilkenny C, Lawrence-Jones A, Di Simplicio M, Nicholls D, Aylin Pet al.,

    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
    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

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