Imperial College London

ProfessorRifatAtun

Faculty of MedicineDepartment of Infectious Disease

Visiting Professor
 
 
 
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Contact

 

+44 (0)20 7594 9160r.atun Website

 
 
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Location

 

289aBusiness School BuildingSouth Kensington Campus

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Summary

 

Publications

Publication Type
Year
to

509 results found

Lee TY, Anindya K, Ng N, Atun R, Marthias T, Zhao Y, McPake B, van Heusden A, Pan Tet al., 2021, Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis, BMC Health Services Research, ISSN: 1472-6963

Journal article

Rocha R, Atun R, Massuda A, Rache B, Spinola P, Nunes L, Lago M, Castro MCet al., 2021, Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis., Lancet Glob Health

BACKGROUND: COVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease). METHODS: From several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities. FINDINGS: The initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather t

Journal article

Hricak H, Abdel-Wahab M, Atun R, Lette MM, Paez D, Brink JA, Donoso-Bach L, Frija G, Hierath M, Holmberg O, Khong P-L, Lewis JS, McGinty G, Oyen WJG, Shulman LN, Ward ZJ, Scott AMet al., 2021, Medical imaging and nuclear medicine: a Lancet Oncology Commission, LANCET ONCOLOGY, Vol: 22, Pages: E136-E172, ISSN: 1470-2045

Journal article

Ahmad R, Atun R, Birgand G, Castro-Sánchez E, Charani E, Ferlie E, Hussain I, Kambugu A, Labarca J, Levy Hara G, Mckee M, Mendelson M, Singh S, Varma J, Zhu J, Zingg W, Holmes Aet al., 2021, Macro level influences on strategic responses to the COVID-19 pandemic – an international survey and tool for national assessments, Journal of Global Health, ISSN: 2047-2978

Background Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning.Methods A cross-sectional electronic survey of health and non-healthcare professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains – Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks.Results 928 respondents from 66 countries (57% healthcare professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains. Conclusions The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.

Journal article

Bulstra CA, Reddy CL, Atun R, Bärnighausen T, Hontelez JACet al., 2021, Impact of the COVID-19-related global recession on the financing of the global HIV response., AIDS

Journal article

Sudharsanan N, Theilmann M, Kirschbaum TK, Manne-Goehler J, Azadnajafabad S, Bovet P, Chen S, Damasceno A, De Neve J-W, Dorobantu M, Ebert C, Farzadfar F, Gathecha G, Gurung MS, Jamshidi K, Jorgensen JMA, Labadarios D, Lemp J, Lunet N, Mwangi JK, Moghaddam SS, Bahendeka SK, Zhumadilov Z, Barnighausen T, Vollmer S, Atun R, Davies JI, Geldsetzer Pet al., 2021, Variation in the Proportion of Adults in Need of Blood Pressure-Lowering Medications by Hypertension Care Guideline in Low- and Middle-Income Countries A Cross-Sectional Study of 1 037 215 Individuals From 50 Nationally Representative Surveys, CIRCULATION, Vol: 143, Pages: 991-1001, ISSN: 0009-7322

Journal article

Lee TY, Hulse E, Atun R, McPake Bet al., 2021, Use of social impact bonds in financing health systems responses to non-communicable diseases: scoping review, BMJ Global Health, Vol: 6, Pages: 1-15, ISSN: 2059-7908

There is an interest to understand how social impact bonds (SIBs), a type of innovative financing instrument used in impact investment, can be used to finance the prevention of non-communicable diseases (NCDs). This is the first scoping review that explores the evidence of SIBs for NCDs and their key characteristics and performance. The review used both published and grey literature from eight databases (MEDLINE, NCBI, Elsevier, Cochrane Library, Google, Google Scholar, WHO publications and OECD iLibrary). A total of 83 studies and articles were eligible for inclusion, identifying 11 SIBs implemented in eight countries. The shared characteristics of the SIBs used for NCDs were impact investment companies as investors, local governments as outcome payers, not-for-profit service providers and an average US$2 015 456 private initial investment. The review revealed a lack of empirical evidence on SIBs for NCDs. Conflict of interest and lack of public disclosure were common issues in both the published and grey literature on SIBs. Furthermore, only three SIBs implemented for financing NCDs were meeting all their target outcomes. The common characteristics of the SIBs meeting their target outcomes were evidence-based interventions, multiple service providers and an intermediated structure. Overall, there is a need for more high-quality studies, particularly economic evaluations and qualitative studies on the benefits to target populations, and greater transparency from the private sector, in order to ensure improved SIBs for preventing NCDs.

Journal article

Howell J, Pedrana A, Schroeder SE, Scott N, Aufegger L, Atun R, Baptista-Leite R, Hirnschall G, 't Hoen E, Hutchinson SJ, Lazarus J, Olufunmilayo L, Peck R, Sharma M, Sohn AH, Thompson A, Thursz M, Wilson D, Hellard Met al., 2021, A global investment framework for the elimination of hepatitis B, JOURNAL OF HEPATOLOGY, Vol: 74, Pages: 535-549, ISSN: 0168-8278

Journal article

Peiris D, Ghosh A, Manne-Goehler J, Jaacks LM, Theilmann M, Marcus ME, Zhumadilov Z, Tsabedze L, Supiyev A, Silver BK, Sibai AM, Norov B, Mayige MT, Martins JS, Lunet N, Labadarios D, Jorgensen JMA, Houehanou C, Guwatudde D, Gurung MS, Damasceno A, Aryal KK, Andall-Brereton G, Agoudavi K, McKenzie B, Webster J, Atun R, Baernighausen T, Vollmer S, Davies JI, Geldsetzer Pet al., 2021, Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data, PLOS MEDICINE, Vol: 18, ISSN: 1549-1277

Journal article

Ward ZJ, Scott AM, Hricak H, Atun Ret al., 2021, Global costs, health benefits, and economic benefits of scaling up treatment and imaging modalities for survival of 11 cancers: a simulation-based analysis, LANCET ONCOLOGY, Vol: 22, Pages: 341-350, ISSN: 1470-2045

Journal article

Pan T, Mercer S, Zhao Y, McPake B, Desloge A, Atun R, Hulse E, Lee TYet al., 2021, The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis, BMC Public Health, Vol: 21, ISSN: 1471-2458

BackgroundThe co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China.MethodsPanel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes.ResultsAfter adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss.ConclusionMental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of int

Journal article

Zhu J, Ferlie E, Castro-Sánchez E, Birgand G, Holmes A, Atun R, Kieltyka H, Ahmad Ret al., 2021, Macro level factors influencing strategic responses to emergent pandemics: a scoping review, Journal of Global Health, ISSN: 2047-2978

Background: Strategic planning is critical for successful pandemic management. This study aimed to identify and review the scope and analytic depth of situation analyses conducted to understand their utility, and capture the documented macro-level factors impacting4pandemic management. Methods: To synthesise this disparate body of literature, we adopted a two-step search and 6review process. A systematic search of the literature was conducted to identify all studies since 2000, that have 1) employed a situation analysis;and2) examined contextual factors influencing pandemic management. The included studies are analysed using a seven-domain systems approach rom the discipline of strategic management. Findings: Nineteen studies were included in the final review ranging from single country (6) to regional, multi-country studies (13). Fourteen studies had a single disease focus, with 5 studies evaluating responses to one or more of COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS),Influenza A (H1N1),Ebola virus disease, and Zika virus disease pandemics. Six studies examined a single domain from political, economic, sociological, technological, ecological or wider industry(PESTELI), 5 studies examined two to four domains, and8studies examined five or more domains. Methods employed were predominantly literature reviews. The recommendations focus predominantly on addressing inhibitors in the sociological and technological domains with few recommendations articulated in the political domain. Overall, the legislative domain is least represented. Conclusions: Ex-post analysis using the seven-domain strategic management framework provides further opportunities for a planned systematic response to pandemics which remains critical as the current COVID-19 pandemic evolves.

Journal article

Lebcir R, Atun R, 2021, Resources management impact on neonatal services performance in the United Kingdom: A system dynamics modelling approach, INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, ISSN: 0749-6753

Journal article

Marthias T, Anindya K, Ng N, McPake B, Atun R, Arfyanto H, Hulse E, Zhao Y, Jusril H, Pan T, Ishida M, Lee TYet al., 2021, Impact of noncommunicable disease multimorbidity on health service use, catastrophic health expenditure, and productivity loss in Indonesia: a population-based panel data analysis study, BMJ Open, Vol: 11, ISSN: 2044-6055

Objectives To examine non-communicable diseases (NCDs) multimorbidity level and its relation to households’ socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss.Design This study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5).Setting The original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population.Participants We included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents.Primary outcome measures We examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables,Results Women were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD.Conclusions NCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbi

Journal article

Virk A, Croke K, Mohd Yusoff M, Mokhtaruddin K, Abdullah Z, Nadziha Mohd Hanafiah A, Soleha Ramli E, Filzatun Borhan N, Almodovar Diaz Y, Aun YW, Atun Ret al., 2020, Hybrid Organizations in Health Systems: The Corporatization of Malaysia's National Heart Institute, HEALTH SYSTEMS & REFORM, Vol: 6, ISSN: 2328-8604

Journal article

Ishida M, Hulse ESG, Mahar RK, Gunn J, Atun R, McPake B, Tenneti N, Anindya K, Armstrong G, Mulcahy P, Carman W, Lee JTet al., 2020, The Joint Effect of Physical Multimorbidity and Mental Health Conditions Among Adults in Australia, PREVENTING CHRONIC DISEASE, Vol: 17, ISSN: 1545-1151

Journal article

Reddy CL, Vervoort D, Meara JG, Atun Ret al., 2020, Surgery and universal health coverage: Designing an essential package for surgical care expansion and scale-up, JOURNAL OF GLOBAL HEALTH, Vol: 10, ISSN: 2047-2978

Journal article

Husin M, Ab Rahman N, Wong XC, Noh KM, Tong SF, Schafer W, Boerma W, Atun R, Sivasampu Set al., 2020, Recruitment and participation of a survey in a public-private primary care setting: experience from the QUALICOPC Malaysia, PRIMARY HEALTH CARE RESEARCH AND DEVELOPMENT, Vol: 21, ISSN: 1463-4236

Journal article

Davies JI, Reddiar SK, Hirschhorn LR, Ebert C, Marcus M-E, Seiglie JA, Zhumadilov Z, Supiyev A, Sturua L, Silver BK, Sibai AM, Quesnel-Crooks S, Norov B, Mwangi JK, Omar OM, Wong-McClure R, Mayige MT, Martins JS, Lunet N, Labadarios D, Karki KB, Kagaruki GB, Jorgensen JMA, Hwalla NC, Houinato D, Houehanou C, Guwatudde D, Gurung MS, Bovet P, Bicaba BW, Aryal KK, Msaidie M, Andall-Brereton G, Brian G, Stokes A, Vollmer S, Barnighausen T, Atun R, Geldsetzer P, Manne-Goehler J, Jaacks LMet al., 2020, Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries: A multicountry analysis of survey data, PLOS MEDICINE, Vol: 17, ISSN: 1549-1277

Journal article

Garcia PJ, Alarcon A, Bayer A, Buss P, Guerra G, Ribeiro H, Rojas K, Saenz R, Salgado de Snyder N, Solimano G, Torres R, Tobar S, Tuesca R, Vargas G, Atun Ret al., 2020, COVID-19 Response in Latin America, AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, Vol: 103, Pages: 1765-1772, ISSN: 0002-9637

Journal article

Haacker M, Hallett T, Atun R, 2020, On time horizons in health economic evaluations, Health Policy and Planning, Vol: 35, Pages: 1237-1243, ISSN: 0268-1080

The issue of time horizons has received scant attention in discussions pertaining to health economic evaluations unlike discounting or translation of health outcomes into life-cycle measures (e.g. Quality Adjusted Life Years (QALYs) or Disability Adjusted Life Years (DALYs)). The available guidelines do not offer clear and consistent guidance for many problems addressed in health economic evaluations. In practice, variation of time horizons between studies for the same diseases is a matter of concern, as results on cost-effectiveness depend on the time horizon. Our paper contributes to establishing a consistent approach to setting time horizons across common types of health economic evaluations and mitigating potential bias where the choice of a time horizon may affect results of the evaluation. We find that available guidance is clear only for patient-focused interventions, but not in the presence of population-level effects owing to transmission of infections or other linkages. We distinguish between a policy period – over which an intervention is delivered or initiated – and an evaluation period over which the effects are measured. One important challenge in establishing a time horizon for evaluation is that, at least for infectious diseases, the state of the epidemic at the end of the policy period cannot be evaluated precisely and incorporated in the results of an economic evaluation. While longer policy periods partly mitigate this challenge, they are subject to greater uncertainty, and outcomes may not adequately reflect the cost-effectiveness of current policies because outcomes reflect an average over the policy period. Incremental analysis on interventions implemented in sub-periods of the policy period (especially at the beginning) potentially improves accuracy and helps to identify potential for improving cost-effectiveness by varying the path of implementation or the mix of interventions offered over time.

Journal article

Lemp JM, De Neve J-W, Bussmann H, Chen S, Manne-Goehler J, Theilmann M, Marcus M-E, Ebert C, Probst C, Tsabedze-Sibanyoni L, Sturua L, Kibachio JM, Moghaddam SS, Martins JS, Houinato D, Houehanou C, Gurung MS, Gathecha G, Farzadfar F, Dryden-Peterson S, Davies J, Atun R, Vollmer S, Barnighausen T, Geldsetzer Pet al., 2020, Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 324, Pages: 1532-1542, ISSN: 0098-7484

Journal article

Bukhman G, Mocumbi AO, Atun R, Becker AE, Bhutta Z, Binagwaho A, Clinton C, Coates MM, Dain K, Ezzati M, Gottlieb G, Gupta I, Gupta N, Hyder AA, Jain Y, Kruk ME, Makani J, Marx A, Miranda JJ, Norheim OF, Nugent R, Roy N, Stefan C, Wallis L, Mayosi Bet al., 2020, The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion, LANCET, Vol: 396, Pages: 991-1044, ISSN: 0140-6736

Journal article

Teufel F, Geldsetzer P, Manne-Goehler J, Karlsson O, Koncz V, Deckert A, Theilmann M, Marcus M-E, Ebert C, Seiglie JA, Agoudavi K, Andall-Brereton G, Gathecha G, Gurung MS, Guwatudde D, Houehanou C, Hwalla N, Kagaruki GB, Karki KB, Labadarios D, Martins JS, Msaidie M, Norov B, Sibai AM, Sturua L, Tsabedze L, Wesseh CS, Davies J, Atun R, Vollmer S, Subramanian SV, Baernighausen T, Jaacks LM, De Neve J-Wet al., 2020, Analysis of Attained Height and Diabetes Among 554,122 Adults Across 25 Low- and Middle-Income Countries, DIABETES CARE, Vol: 43, Pages: 2403-2410, ISSN: 0149-5992

Journal article

Pedrana A, Howell J, Scott N, Schroeder S, Kuschel C, Lazarus J, Atun R, Baptista-Leite R, t'Hoen E, Hutchinson SJ, Aufegger L, Peck R, Sohn AH, Swan T, Thursz M, Lesi O, Sharma M, Thwaites J, Wilson DP, Hellard Met al., 2020, Global hepatitis C elimination: an investment framework, LANCET GASTROENTEROLOGY & HEPATOLOGY, Vol: 5, Pages: 927-939

Journal article

Head MG, Brown RJ, Newell M-L, Scott JAG, Batchelor J, Atun Ret al., 2020, The allocation of US$105 billion in global funding from G20 countries for infectious disease research between 2000 and 2017: a content analysis of investments, LANCET GLOBAL HEALTH, Vol: 8, Pages: E1295-E1304, ISSN: 2214-109X

Journal article

Sivasampu S, Teh XR, Lim YMF, Ong SM, Ang SH, Husin M, Khamis N, Jaafar FSA, Wong WJ, Shanmugam S, Ismail SA, Pang SHL, Nasir NH, Ismail MS, Kusuma D, Ross-Degnan D, Atun Ret al., 2020, Study protocol on Enhanced Primary Healthcare (EnPHC) interventions: a quasi-experimental controlled study on diabetes and hypertension management in primary healthcare clinics, Primary Health Care Research and Development, Vol: 21, Pages: 1-12, ISSN: 1463-4236

Aim:This paper describes the study protocol, which aims to evaluate the effectiveness of a multifaceted intervention package called ‘Enhanced Primary Healthcare’ (EnPHC) on the process of care and intermediate clinical outcomes among patients with Type 2 diabetes mellitus (T2DM) and hypertension. Other outcome measures include patients’ experience and healthcare providers’ job satisfaction.Background:In 2014, almost two-thirds of Malaysia’s adult population aged 18 years or older had T2DM, hypertension or hypercholesterolaemia. An analysis of health system performance from 2016 to 2018 revealed that the control and management of diabetes and hypertension in Malaysia was suboptimal with almost half of the patients not diagnosed and just one-quarter of patients with diabetes appropriately treated. EnPHC framework aims to improve diagnosis and effective management of T2DM, hypertension or hypercholesterolaemia and their risk factors by increasing prevention, optimising management and improving surveillance of diagnosed patients.Methods:This is a quasi-experimental controlled study which involves 20 intervention and 20 control clinics in two different states in Malaysia, namely Johor and Selangor. The clinics in the two states were matched and randomly allocated to ‘intervention’ and ‘control’ arms. The EnPHC framework targets different levels from community to primary healthcare clinics and integrated referral networks.Data are collected via a retrospective chart review (RCR), patient exit survey, healthcare provider survey and an intervention checklist. The data collected are entered into tablet computers which have installed in them an offline survey application. Interrupted time series and difference-in-differences (DiD) analyses will be conducted to report outcomes.

Journal article

Zhu J, Ahmad R, Holmes A, Robotham J, Lebcir R, Atun Ret al., 2020, System dynamics modelling to formulate policy interventions to optimise antibiotic prescribing in hospitals, Journal of the Operational Research Society, ISSN: 0160-5682

Multiple strategies have been used in the National Health System (NHS) in England to reduce inappropriate antibiotic prescribing and consumption in order to tackle antimicrobial resistance. These strategies have included, among others, restricting dispensing, introduction of prescribing guidelines, use of clinical audit, and performance reviews as well as strategies aimed at changing the prescribing behaviour of clinicians. However, behavioural interventions have had limited effect in optimising doctors’ antibiotic prescribing practices. This study examines the determinants of decision-making for antibiotic prescribing in hospitals in the NHS. A system dynamics model was constructed to capture structural and behavioural influences to simulate doctors’ prescribing practices. Data from the literature, patient records, healthcare professional interviews and survey responses were used to parameterise the model. The scenario simulation shows maximum improvements in guideline compliance are achieved when compliance among senior staff is increased, combined with fast laboratory turnaround of blood cultures, and microbiologist review. Improving guideline compliance of junior staff alone has limited impact. This first use of system dynamics modelling to study antibiotic prescribing decision-making demonstrates the applicability of the methodology for design and evaluation of future policies and interventions.

Journal article

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