196 Chapter 7 Future perspectives The overarching goal of this thesis was to find starting points to improve the prescribing of antimicrobials to slow down the unavoidable increasing prevalence of AMR. The results from this thesis showed that antimicrobial prescribing in Dutch primary care can generally be considered as prudent. Dutch GPs tend to follow the recommendations provided by the guidelines (chapter 6), resulting in a lower prescription rate in primary care when compared to many other European countries (65). However, there is still room for improvement as can be deducted from the results of the studies described in chapter 5 and 6. Here we found that there is an overprescribing of antimicrobial therapy for RTIs and that there is an overuse of macrolides. In addition, the incorrect registrations of antibiotic allergies lead to avoidable prescription of broad-spectrum instead of low-spectrum antimicrobials. It is clear that these elements need to be improved. An extra challenge in primary care regarding AMR is formed by epidemiological changes in the Dutch population, such as aging and the therewith increasing number of co-morbidities. Both are associated with antimicrobial overprescribing (chapter 3 and 6) and will probably lead to more antimicrobial use in the long-term with the risk of an increasing AMR prevalence. This makes the previously described need for improvement and continuation of already prudent antimicrobial prescribing practices even more important. The aging population and increasing number of comorbidities will increase patients need to consult a GP for RTI symptoms as they seek reassurance (10-12). This need can not only be addressed through consultation in a primary care practice, as GPS are already experiencing to be overloaded with work. To address this need, other ways of communicating with and informing of patients has to be researched and implemented. For example, mass media campaigns informing patients on the self-limiting character of RTIs and interactive websites or smartphone apps informing patients when they have contact the primary care. Another aspect regarding interventions, they have to focus on patient groups who visit a primary care practice more often and use more antimicrobials, as current interventions are mostly ‘one size fits all’. There is a need for tailored made interventions as shown in this thesis. For example, compared with other migrants groups, patients with a Turkish, Surinamese and Dutch-Caribbean background were more often prescribed inappropriate antimicrobials (chapter 6). This finding highlights our current lack of knowledge concerning the influence of migrant and cultural
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