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Prototype Prescribing Outlier Dashboard for Wrekenton Medical Group

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 Wrekenton Medical Group is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glycopyrronium bromide 644 Antimuscarinic bronchodilators 906 0.71 0.06 0.10 6.58
Liraglutide 156 Other antidiabetic drugs 1,000 0.16 0.03 0.03 4.83
Risperidone 15 Antipsychotic depot injections 15 1.00 0.08 0.21 4.44
Dimeticone (Parasiticidal) 6 Parasiticidal preparations 11 0.55 0.04 0.12 4.33
Colesevelam hydrochloride 198 Lipid-regulating drugs 17,924 0.01 0.00 0.00 3.96
Indacaterol/glycopyrronium 167 Compound bronchodilator preparations 181 0.92 0.15 0.20 3.89
Phenoxybenzamine hydrochloride 4 Alpha-adrenoceptor blocking drugs 1,172 0.00 0.00 0.00 3.83
Cyproterone acetate 37 Prostate cancer and gonadorelin analogues 121 0.31 0.03 0.08 3.25
Chlorothiazide 8 Thiazides and related diuretics 1,745 0.00 0.00 0.00 3.17
Paracetamol 7,702 Non-opioid analgesics and compound preparations 7,766 0.99 0.48 0.16 3.14

Prescribing where Wrekenton Medical Group is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-codamol (Codeine phosphate/paracetamol) 8 Non-opioid analgesics and compound preparations 7,766 0.00 0.45 0.15 -2.93
Tiotropium bromide 194 Antimuscarinic bronchodilators 906 0.21 0.71 0.18 -2.77
Ramipril 2,876 Angiotensin-converting enzyme inhibitors 8,995 0.32 0.69 0.17 -2.26
Azathioprine 22 Antiproliferative immunosuppressants 55 0.40 0.80 0.19 -2.17
Levonorgestrel 0 Emergency contraception 5 0.00 0.61 0.31 -1.97
    Calcipotriol 126 Preparations for psoriasis 176 0.72 0.87 0.08 -1.94
    Nitrofurantoin 506 Urinary-tract infections 593 0.85 0.96 0.06 -1.88
    Prochlorperazine maleate 90 Drugs used in nausea and vertigo 940 0.10 0.25 0.08 -1.82
    Tamsulosin hydrochloride 1,513 Drugs for urinary retention 1,853 0.82 0.92 0.06 -1.73
    Citalopram hydrobromide 1,827 Selective serotonin re-uptake inhibitors 10,338 0.18 0.32 0.08 -1.69