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Prototype Prescribing Outlier Dashboard for William Brown Centre

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 William Brown Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Distigmine bromide 5 Drugs for urinary retention 2,702 0.00 0.00 0.00 122.59
Ciprofloxacin/fluocinolone 59 Otitis externa 341 0.17 0.00 0.01 20.82
Imidapril hydrochloride 199 Angiotensin-converting enzyme inhibitors 13,499 0.01 0.00 0.00 19.65
Baricitinib 1 Rheumatic disease suppressant drugs 330 0.00 0.00 0.00 9.21
Xylometazoline hydrochloride/ipratropium bromide 1 Topical nasal decongestants 67 0.01 0.00 0.00 6.37
Aceclofenac 25 Non-steroidal anti-inflammatory drugs 2,488 0.01 0.00 0.00 4.00
Acebutolol hydrochloride 31 Beta-adrenoceptor blocking drugs 13,132 0.00 0.00 0.00 3.88
Dexpanthenol 18 Emollients 715 0.03 0.00 0.01 3.67
Carbomer 940/980 971 Tear deficiency, eye lubricant/astringent 1,252 0.78 0.34 0.15 2.95
Tamsulosin and dutasteride hydrochloride 284 Drugs for urinary retention 2,702 0.11 0.02 0.03 2.80

Prescribing where William Brown Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Acamprosate calcium 0 Alcohol dependence 6 0.00 0.83 0.31 -2.69
    Folic acid 1,234 Drugs used in megaloblastic anaemias 4,490 0.27 0.69 0.16 -2.66
    Hydralazine hydrochloride 10 Vasodilator antihypertensive drugs 41 0.24 0.85 0.28 -2.17
    Levonorgestrel 0 Emergency contraception 4 0.00 0.61 0.31 -1.97
      Hypromellose 201 Tear deficiency, eye lubricant/astringent 1,252 0.16 0.45 0.15 -1.90
      Zinc sulfate monohydrate 0 Zinc 8 0.00 0.74 0.39 -1.90
        Nicotine 1 Nicotine dependence 32 0.03 0.65 0.33 -1.86
        Omeprazole 5,640 Proton pump inhibitors 22,313 0.25 0.50 0.16 -1.51
        Tamsulosin hydrochloride 2,241 Drugs for urinary retention 2,702 0.83 0.92 0.06 -1.51
        Combined ethinylestradiol 35mcg 0 Combined hormonal contraceptives 346 0.00 0.05 0.04 -1.47