149 Routine data registries as a basis to analyse and improve the quality of antimicrobial prescription in Primary Care 6 between 2,186 and 4,336 registered patients, and a large practice had >4,336 registered patients. Primary care practices were defined as outliers if the number of antimicrobial prescriptions was lower than 120 or higher than 750 antimicrobial prescriptions per 1000 patients per year. These outliers were attributed to incomplete EMRs. Data from these practices were not used in the final multivariable regression analyses. Day of prescription was divided into Monday-Thursday or Friday. The variable was categorized as dichotomous and Friday was used as the reference day of prescription. Statistical analyses Descriptive statistics were used to describe variables and trends of antimicrobial prescribing. Paired sample t-tests were performed to test for statistically significant differences (p<0,05) between number of antimicrobial prescriptions per year and the day of antimicrobial prescribing. Multivariable logistic regression analyses were performed to examine potential associations of the determinants with appropriate antimicrobial prescribing using four different models. Model 1 included gender (ref=female) and age (ref=0-4 years). Model 2 additionally included migration background (ref=Dutch). Model 3 added number of parents in household (ref=2 parents), household income (ref=low income) and number of comorbidities (ref=0 comorbidities). Model 4 additionally included size of primary care practice (ref=small size) and day of prescription (ref=Friday). Furthermore, a multivariable logistic regression analysis using model four was conducted. This analysis examined possible associations of determinants of appropriate antimicrobial prescribing for RTIs only. To check for possible bias due to missing patient data in SN database, a multivariable regression analysis was conducted that included patients with no determinants in the SN data. Results Trend of antimicrobial prescriptions In our analyses, we included 1,150,252 antimicrobial prescriptions for 269,574 patients (56.7% female gender) (Table 1), with Dutch as the most prevalent migration background (69.3%). Approximately 50% of patients had a low income or were registered in a medium sized primary care practice. Fourteen primary care practices were excluded from the multivariable regression analysis, as data were missing on the total number of registered patients. The average number of antimicrobial prescriptions between the years 2012-2019 was 131,311 per year (range 124,154 – 138,255). In 2020 there were 99,762 antimicrobial prescriptions, which is a statistically significant decline
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