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Prototype Prescribing Outlier Dashboard for Fellview Healthcare

At OpenPrescribing we are piloting a number of data-driven approaches to identify unusual prescribing and collect feedback on this prescribing to inform development of new tools to support prescribers and organisations to audit and review prescribing. These pilot results are provided for the interest of advanced users, although we don't know how relevant they are in practice. There is substantial variation in prescribing behaviours, across various different areas of medicine. Some variation can be explained by demographic changes, or local policies or guidelines, but much of the remaining variation is less easy to explain.

The DataLab is keen to hear your feedback on the results. You can do this by completing the following survey or emailing us at [email protected]. Please DO NOT INCLUDE IDENTIFIABLE PATIENT information in your feedback. All feedback is helpful, you can send short or detailed feedback.

This report has been developed to automatically identify prescribing patterns at a chemical level which are furthest away from “typical prescribing” and can be classified as an “outlier”. We calculate the number of prescriptions for each chemical in the BNF coding system, the count of all prescriptions within that chemical's BNF subparagraph, for prescriptions dispensed between June 2021 and December 2021. We then calculate the ratio of these counts along with the mean and standard deviation of those ratios across all Practices. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given Practice is from the population mean. We then rank your “z-scores” to find the top 10 results where prescribing is an outlier for prescribing higher than its peers and those where it is an outlier for prescribing lower than its peers.

For each outlier chemical, a kernel density estimation plot of all Practice's chemical:subparagraph ratios is provided, with this Practice's ratio overlaid in red.

It is important to remember that this information was generated automatically and it is therefore likely that some of the behaviour is warranted. This report seeks only to collect information about where this variation may be warranted and where it might not, to inform research on this topic. Our full analytical method code is openly available on GitHub here.

This is a new, experimental feature. We'd love to .

Prescribing where Fellview Healthcare is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Deferiprone 5 Hypoplastic/haemolytic and renal anaemias 5 1.00 0.01 0.09 10.60
Other otitis external preparations 1 Otitis externa 311 0.00 0.00 0.00 6.19
Alitretinoin 1 Preparations for eczema 1 1.00 0.03 0.17 5.64
Low protein cakes 12 Foods for special diets 448 0.03 0.00 0.01 4.62
Other magnesium preparations 67 Magnesium 212 0.32 0.01 0.07 4.57
Erdosteine 60 Mucolytics 1,173 0.05 0.00 0.01 4.26
Clomethiazole 43 Hypnotics 2,180 0.02 0.00 0.01 3.25
Dipyridamole and aspirin 1 Antiplatelet drugs 13,128 0.00 0.00 0.00 3.06
Umeclidinium bromide 461 Antimuscarinic bronchodilators 967 0.48 0.12 0.13 2.80
Diphenhydramine hydrochloride 96 Antihistamines 4,998 0.02 0.00 0.01 2.63

Prescribing where Fellview Healthcare is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gamolenic acid 0 Preparations for eczema 1 0.00 0.90 0.30 -3.04
    Mercaptopurine 0 Antimetabolites 13 0.00 0.80 0.35 -2.32
      Tiotropium bromide 345 Antimuscarinic bronchodilators 967 0.36 0.71 0.18 -1.97
      Losartan potassium 1,445 Angiotensin-II receptor antagonists 8,595 0.17 0.50 0.19 -1.79
      Indapamide 593 Thiazides and related diuretics 4,082 0.15 0.43 0.16 -1.78
      Naftidrofuryl oxalate 1 Peripheral vasodilators and related drugs 33 0.03 0.67 0.39 -1.65
      Sodium picosulfate 0 Bowel cleansing preparations 14 0.00 0.69 0.43 -1.61
        Atorvastatin 12,733 Lipid-regulating drugs 23,390 0.54 0.67 0.08 -1.54
        Senna 845 Stimulant laxatives 2,414 0.35 0.55 0.14 -1.46
        Buprenorphine 96 Opioid analgesics 12,170 0.01 0.12 0.08 -1.40