Antimicrobial prescribing, Quality of care, Primary care, Electronic data extraction
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.