210 English summary The main determinants of antimicrobial overprescribing were diagnostic uncertainty, GP practice size (perhaps as a measure of time available during consultations), inability to effectively negotiate or explain antimicrobial use and GPs' assumption that patients 'expect an antimicrobial prescription'. There are three major aspects in which antibiotic prescribing in general practices can be improved. There is antibiotic overprescribing for patients with respiratory tract infections. Instead of the broad-spectrum antibiotic group macrolides, narrow-spectrum antibiotics can be chosen frequently. Finally, antibiotics are relatively over-prescribed to patients from specific migratory backgrounds (Turkish, Dutch-Caribbean, Surinamese). In addition, registration of antibiotic allergies can be improved by educating GPs to increase awareness and knowledge of antibiotic allergies, by verifying existing registrations of antibiotic allergies and by facilitating registration in an EHR so that the different EHRs are more compatible and do not contradict each other. This may lead to a reduction in the number of antibiotic allergy registrations and thus contribute to the prescription of first-choice antimicrobials instead of second-choice (broadspectrum) antimicrobials. The increasing prevalence of AMR requires up-to-date and more proactive surveillance of antimicrobial use and resistance in primary care. If antimicrobial use and in particular the use of broad-spectrum antimicrobials or resistant bacterial groups increases, actions can be taken to address these developments. For example, through adjustments in national guidelines, messages in newsletters of national organisations or attention to these developments in pharmacotherapy education. Artificial Intelligence (AI) and/or big data can contribute to improved surveillance. The studies in this thesis show that big data can be used to analyse antimicrobial use. This has let to the discovery of relevant associations, such as antimicrobial prescriptions and practice size. The use of AI in surveillance and analysis of antimicrobial prescribing behaviour maybe the next step to be investigated in this regard.
RkJQdWJsaXNoZXIy MTk4NDMw