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Prototype Prescribing Outlier Dashboard for Ashburn Medical 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 Ashburn Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chloramphenicol 7 Otitis externa 105 0.07 0.00 0.00 18.60
Dronedarone hydrochloride 7 Drugs for arrhythmias 10 0.70 0.02 0.06 10.99
Acrivastine 30 Antihistamines 653 0.05 0.00 0.01 7.62
Doxepin 32 Tricyclic and related antidepressant drugs 1,124 0.03 0.00 0.00 7.17
Cyproterone acetate 32 Prostate cancer and gonadorelin analogues 58 0.55 0.03 0.08 6.19
Solifenacin/tamsulosin 59 Drugs for urinary retention 728 0.08 0.01 0.01 5.14
Glycopyrronium bromide 145 Antimuscarinic bronchodilators 318 0.46 0.06 0.10 4.00
Ciprofibrate 22 Lipid-regulating drugs 7,686 0.00 0.00 0.00 3.98
Eflornithine monohydrate chloride 16 Shampoos and some other scalp preparations 103 0.16 0.02 0.03 3.96
Beclometdiprop/formoterol/glycopyrronium 504 Selective beta(2)-agonists 2,282 0.22 0.06 0.04 3.87

Prescribing where Ashburn Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Salbutamol 1,772 Selective beta(2)-agonists 2,282 0.78 0.91 0.04 -2.92
Ramipril 1,092 Angiotensin-converting enzyme inhibitors 4,519 0.24 0.69 0.17 -2.73
Ivermectin 1 Topical preparation for rosacea 3 0.33 0.88 0.22 -2.45
Senna 179 Stimulant laxatives 764 0.23 0.55 0.14 -2.29
Nitrofurantoin 183 Urinary-tract infections 220 0.83 0.96 0.06 -2.24
Clarithromycin 61 Macrolides 263 0.23 0.57 0.16 -2.13
Tamsulosin hydrochloride 578 Drugs for urinary retention 728 0.79 0.92 0.06 -2.11
Hydroxychloroquine sulfate 2 Rheumatic disease suppressant drugs 42 0.05 0.37 0.16 -2.06
Omeprazole 1,106 Proton pump inhibitors 6,503 0.17 0.50 0.16 -2.03
Losartan potassium 261 Angiotensin-II receptor antagonists 1,938 0.13 0.50 0.19 -1.97