Martijn Sijbom

157 Routine data registries as a basis to analyse and improve the quality of antimicrobial prescription in Primary Care 6 Implications for practice Our findings may open up important implications entries for antimicrobial stewardship especially related to RTIs and macrolide use. Our first recommendation is to increase and improve feedback on antimicrobial prescribing, as this is a proven AMS intervention that reduces antimicrobial prescribing (48-52), making use of the determinants we found and focusing on RTIs and macrolides. The second recommendation is to provide room for extended consultation time by reducing practice workload. We hypothesize this can lead to less antimicrobial overprescribing, as it supports the clinical quality of primary care practice. A third recommendation might be the provision of information targeted to groups with a specific migration background, for example through public information campaigns. Further research into effective interventions tailored to specific migration backgrounds might still be needed. Conclusion Our study shows that data from two large registries can be used to examine the broader context of medical issues, in this case patterns of antimicrobial prescription. This approach is applicable to any health registry where corresponding individual or household socioeconomic data is relevant to explore. In our study, we gained new insights and uncovered previously unknown associations with antimicrobial prescription behaviour on patient and practice level. We advise action to improve antimicrobial prescribing especially for RTIs in primary care and explore entries to lower the number of macrolide prescriptions when they are not explicitly needed. Regarding overall antimicrobial overprescribing, we propose that any intervention would benefit from targeted endeavours to reduce practice workload and increase the room for extended consultation time per patient encounter. Antimicrobial prescription quality is another issue that would benefit from improved personal continuity of care in primary care practice and greater availability of culturally-tailored information would help to bridge expectations when organizing shared decision making in antimicrobial prescription.

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