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Prototype Prescribing Outlier Dashboard for Moorlands Surgery

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 Moorlands Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Voriconazole 30 Triazole antifungals 124 0.24 0.00 0.01 42.48
Penciclovir 1 Antiviral preparations 27 0.04 0.00 0.00 12.76
Hydromorphone hydrochloride 76 Opioid analgesics 6,071 0.01 0.00 0.00 10.35
Dibrompropamidine isetionate 1 Antibacterials 124 0.01 0.00 0.00 8.91
Freeze sprays and gels 3 Rubefacients, topical NSAIDS, capsaicin and poultice 1,132 0.00 0.00 0.00 6.81
Propamidine isetionate 3 Antibacterials 124 0.02 0.00 0.00 6.33
Torasemide 89 Loop diuretics 3,195 0.03 0.00 0.00 5.59
Taurine 8 Amino acids and nutritional agents 8 1.00 0.04 0.19 5.06
Promethazine teoclate 90 Drugs used in nausea and vertigo 1,212 0.07 0.00 0.01 5.02
Diphtheria 224 Vaccines and antisera 684 0.33 0.02 0.08 3.70

Prescribing where Moorlands Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aciclovir 26 Antiviral preparations 27 0.96 1.00 0.00 -7.70
Other amino acidandnutritional agent preparations 0 Amino acids and nutritional agents 8 0.00 0.96 0.19 -5.06
    Gliclazide 131 Sulfonylureas 291 0.45 0.93 0.13 -3.54
    Nitrofurantoin 644 Urinary-tract infections 789 0.82 0.96 0.06 -2.50
    Amitriptyline hydrochloride 2,550 Tricyclic and related antidepressant drugs 3,746 0.68 0.84 0.08 -2.12
    Other multivitamin preparations 117 Multivitamin preparations 271 0.43 0.82 0.21 -1.89
    Vitamin E 0 Vitamin E 2 0.00 0.72 0.41 -1.76
      Citalopram hydrobromide 1,484 Selective serotonin re-uptake inhibitors 8,334 0.18 0.32 0.08 -1.67
      Clarithromycin 168 Macrolides 548 0.31 0.57 0.16 -1.67
      Nicorandil 64 Other antianginal drugs 404 0.16 0.50 0.20 -1.67