Aim:Gaining insight into the prescription behaviour of healthcare professionals who work in nursing homes of SVRZ in Zeeland, regarding the prescription of antibiotics for respiratory infections.

Background:These days, pneumonia is the number two most common infectious disease in nursing homes in the Netherlands, after urinary tract infections, and is associated with high numbers of mortality and morbidity.

Design:A mixed method design was used comprising a retrospective file research and a focus group. The antibiotics recipes prescribed from September 2016 to September 2017, where mapped from the files. After that, a focus group consisting of eight healthcare professionals reflected on the possibilities of adjusting prescription policy.

Results:In total 498 recipes with notice of respiratory infections were found, with 11 different sorts of antibiotics prescribed. Thereof, 63, 6% was prescribed according to the NHG guideline ‘acute coughing’and 36, 4% was not. During the focus group, consensus was reached about appropriate antibiotics for complicated respiratory infections in elderly (amoxillin/clav acid, ceftriaxon, amoxillin, and trimethoprim/sulfamethoxazol). At the same time, the focus group provided insights in the reasons for non-adherence to the NHG guidline, with clinical deterioration as the most decisive symptom to start antibiotics.

Conclusion:The results of this study show that healthcare professionals in nursing homes prescribe a variation of antibiotics which are not completely in line with the NHG guideline. Considerations regarding prescription behaviour are influenced by characterisations of vulnerability of elderly people, ‘the clinical view’ and values with regard to meaningful care.

A new systems approach to diseased states and wellness result in a new branch in the healthcare services, namely, personalized medicine (PM). To achieve the implementation of PM concept into the daily practice including clinical cardiology, it is necessary to create a fundamentally new strategy based upon the subclinical recognition of bioindicators (biopredictors and biomarkers) of hidden abnormalities long before the disease clinically manifests itself. Each decision-maker values the impact of their decision to use PM on their own budget and well-being, which may not necessarily be optimal for society as a whole. It would be extremely useful to integrate data harvesting from different databanks for applications such as prediction and personalization of further treatment to thus provide more tailored measures for the patients and persons-at-risk resulting in improved outcomes whilst securing the healthy state and wellness, reduced adverse events, and more cost effective use of health care resources. One of the most advanced areas in cardiology is atherosclerosis, cardiovascular and coronary disorders as well as in yocarditis. A lack of medical guidelines has been identified by the majority of responders as the predominant barrier for adoption, indicating a need for the development of best practices and guidelines to support the implementation of PM into the daily practice of cardiologists!

Implementation of PM requires a lot before the current model 'physician-patient' could be gradually displaced by a new model “medical advisor-healthy person-at-risk. This is the reason for developing global scientific, clinical, social, and educational projects in the area of PM to elicit the content of the new branch.