144 Chapter 6 Abstract Introduction Antimicrobial resistance (AMR) is increasing worldwide, largely due to the overuse of antimicrobial medication. In most countries, 80-90% of antimicrobial prescription originate from primary care. With the goal of examining the quality of prescription, we explored its determinants in combined data from a primary healthcare registry and a national socioeconomic database. Methods Pseudonymized routine healthcare data from 269,547 patients (1,150,252 antimicrobial prescriptions) gathered between 2012 and 2020 from primary care practices in the region The Hague – Leiden were used. These data were linked with individual socioeconomic data to identify determinants of antimicrobial prescribing. The quality of prescription was analysed using predefined criteria based on primary care guidelines. Multivariable logistic regression analyses were performed to identify associations with appropriateness. Results Respiratory tract infections (RTI) were most commonly associated with overprescribing, with 14.5% of RTI prescriptions not following guidelines. For macrolide prescriptions, 77.1% did not correspond with first and second guideline choices. Certain migration backgrounds, female gender, comorbidities, age, and primary care practice size, a proxy for continuity of care and consultation time per patient, were associated with poorer guideline adherence. Discussion Combined analyses of socioeconomic and routinely collected healthcare data does reveal relevant additional information to answer medical questions in a broader context, such as AMR. Most room for improvement was found for RTIs and macrolides, especially in specific risk groups. Assuring continuity of care and/or providing extended consultation time per patient might be essential elements to establish, before disseminating and implementing improvement strategies.
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