ArticleCritical public health2023
Do you see the problem? Visualising a generalised 'complex local system' of antibiotic prescribing across the United Kingdom using qualitative interview data.
Article in Critical public health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A systematic review of national interventions and policies to optimize antibiotic use in healthcare settings in England.The Journal of antimicrobial chemotherapy · 2024Pooled it
- Reviewing ecosystems of evidence: synthesising the evidence on the commercial determinants of health from a complex systems perspective.Systematic reviews · 2026Article
- Method for and potential value of reflexive stakeholder mapping of a policy evaluation team: the example of the national evaluation of the NHS Pharmacy First scheme.Health research policy and systems · 2026Article
- Ten Questions on Using Lung Ultrasonography to Diagnose and Manage Pneumonia in Hospital-at-Home Model: Part III-Synchronicity and Foresight.Diagnostics (Basel, Switzerland) · 2026Review
- Stakeholder views on the implementation of the UK's Antimicrobial Resistance (AMR) National Action Plan (2019-2024) in relation to AMR in the environment.Global health action · 2025Article
- Learning From Self-Care Practices Among Marginalised Women: Towards Embedding Health Justice in the UK Health Policy.Sociology of health & illness · 2025Article
- Article
- Systems thinking to understand the complexity of antimicrobial resistance across One Health: A systematic review of current approaches.One health (Amsterdam, Netherlands) · 2025Review
- Supporting One Health policies to manage antibiotic resistance in Senegal: a systems analysis using group model building.Frontiers in public health · 2025Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Antimicrobial resistance (AMR) is often referred to as a complex problem embedded in a complex system. Despite this insight, interventions in AMR, and in particular in antibiotic prescribing, tend to be narrowly focused on the behaviour of individual prescribers using the tools of performance monitoring and management rather than attempting to bring about more systemic change. In this paper, we aim to elucidate the nature of the local antibiotic prescribing 'system' based on 71 semi-structured interviews undertaken in six local areas across the United Kingdom (UK). We applied complex systems theory and systems mapping methods to our qualitative data to deepen our understanding of the interactions among antibiotic prescribing interventions and the wider health system. We found that a complex and interacting set of proximal and distal factors can have unpredictable effects in different local systems in the UK. Ultimately, enacting performance management-based interventions in the absence of in-depth contextual understandings about other pressures prescribers face is a recipe for temporary solutions, waning intervention effectiveness, and unintended consequences. We hope our insights will enable policy makers and academics to devise and evaluate interventions in future in a manner that better reflects and responds to the dynamics of complex local prescribing systems.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.