147 Routine data registries as a basis to analyse and improve the quality of antimicrobial prescription in Primary Care 6 available to researchers in a secure environment (www.cbs.nl). Data from SN concern household income, migration background and number of parents in each household. Oral antimicrobial prescriptions in the ELAN data warehouse were identified through Anatomical Therapeutic Chemical (ATC) code J01. All oral antimicrobials with ATC code J01 primarily prescribed by a primary care practice between 2012 and 2021 were included. International Classification of Primary Care (ICPC) codes included with the prescription were used to define the reason for prescribing the antimicrobial. In Dutch primary care in our network, ICPC codes version 1 is used to systematically classify symptoms and diseases. Data analysis Antimicrobial prescriptions were analysed using a syntax for appropriateness, which was defined as a prescription in accordance with prevailing Dutch primary care guidelines at the time of prescription (Supplement 3)(13). Antimicrobial prescriptions with an ICPC code corresponding with an infection were included in the analysis on appropriateness. An antimicrobial prescription was considered appropriate if the ICPC code accompanying the prescription matched an indication for an antimicrobial prescription in the Dutch primary care guidelines. If the ICPC code was missing or obviously registered incorrectly, for example for hypertension, the antimicrobial prescription was excluded from the examination on appropriateness and further analysis. In a separate analysis, the choice of an antimicrobial corresponding to the first or second choice antimicrobial in the prevailing guideline was viewed as corresponding to the guideline (Supplement 4). In case of a presumed antimicrobial allergy, Dutch primary care guidelines recommend a third choice. If a patient had an antimicrobial allergy registration for the first and/or second choice antimicrobial, the prescription of this third choice was classified as corresponding to the guideline. The variable ‘appropriateness’ was categorized as dichotomous, using appropriate as the reference category. Primary outcomes were the number of appropriate and inappropriate antimicrobial prescriptions per year over the period 2012-2021. In the ELAN Datawarehouse we identified 1,496,461 unique oral antimicrobial prescriptions by all primary care practices (Supplement 2), of which 122,659 (8.2%) were identified as prophylaxis and subsequently excluded from further analysis. Prescriptions in the year 2021 (n=79,418) were not included because annual data for 2021 were not complete. As SN had no data available for 35,321 patients (with 144,312 antimicrobial prescriptions), these prescriptions were also excluded. In total, 1,150,252 antimicrobial prescriptions for 269,574 unique patients were included in the analysis, as shown in a flowchart (Supplement 2).
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