title: Improving antimicrobial prescribing in Irish primary care through electronic data collection and surveillance: a feasibility study.
abstract: BACKGROUND
  The increase in the spread of antimicrobial resistance (AMR) in bacterial pathogens and limited availability of new antimicrobials places immense pressure on general practitioners (GPs) to prescribe appropriately. Currently, electronic antimicrobial prescribing data is not routinely collected from GPs in Ireland for surveillance purposes to assess regional specific fluctuations or trends in antimicrobial prescribing. The current study aimed to address this issue by assessing the feasibility of remotely extracting antimicrobial prescribing data from primary care practices in Ireland, for the purpose of assessing prescribing quality using the European Surveillance of Antimicrobial Consumption (ESAC) drug specific quality indicators.
  
  
  METHODS
  Participating practices (n = 30) uploaded data to the Irish Primary Care Research Network (IPCRN). The IPCRN data extraction facility is integrated within the practice patient management software system and permitted the extraction of anonymised patient prescriptions for a one year period, from October 2012 to October 2013. The quality of antimicrobial prescribing was evaluated using the twelve ESAC drug specific quality indicators using the defined daily dose (DDD) per 1,000 inhabitants per day (DID) methodology. National and European prescribing surveillance data (based on total pharmacy sales) was obtained for a comparative analysis.
  
  
  RESULTS
  Antimicrobial prescriptions (n = 57,079) for 27,043 patients were obtained from the thirty study practices for a one year period. On average, study practices prescribed a greater proportion of quinolones (37 % increase), in summer compared with winter months, a variation which was not observed in national and European data. In comparison with national data, study practices prescribed higher proportions of β-lactamase-sensitive penicillins (4.98 % vs. 4.3 %) and a greater use of broad spectrum compared to narrow-spectrum antimicrobials (ratio = 9.98 vs. 6.26) was observed. Study practices exceeded the European mean for prescribing combinations of penicillins, including β-lactamase inhibitors.
  
  
  CONCLUSIONS
  This research demonstrates the feasibility and potential use of direct data extraction of anonymised practice data directly through the patient management software system. The data extraction methods described can facilitate the provision of routinely collected data for sustained and inclusive surveillance of antimicrobial prescribing. These comparisons may initiate further improvements in antimicrobial prescribing practices by identifying potential areas for improvement.
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland. Sandra.galvin@nuigalway.ie.
authors.forename: Sandra
authors.initials: S
authors.lastname: Galvin
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland. aoife.callan@nuigalway.ie.|Discipline of Economics, J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland. aoife.callan@nuigalway.ie.
authors.forename: Aoife
authors.initials: A
authors.lastname: Callan
authors.affiliation: Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland. martin.cormican@nuigalway.ie.|Department of Medical Microbiology, University Hospital Galway, Galway, Ireland. martin.cormican@nuigalway.ie.
authors.forename: Martin
authors.initials: M
authors.lastname: Cormican
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland. sinead.duane@nuigalway.ie.
authors.forename: Sinead
authors.initials: S
authors.lastname: Duane
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland. bennettk@tcd.ie.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland. andrew.murphy@nuigalway.ie.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland. akke.vellinga@nuigalway.ie.|Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland. akke.vellinga@nuigalway.ie.
authors.forename: Akke
authors.initials: A
authors.lastname: Vellinga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents; D004363:Drug Utilization / Q000706:statistics & numerical data*; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D016247:Information Storage and Retrieval / Q000379:methods*; D007494:Ireland; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D011785:Quality Assurance, Health Care / Q000379:methods; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents