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Prototype Prescribing Outlier Dashboard for Ashby Turn Primary Care Partners

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 Ashby Turn Primary Care Partners is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sulfur 2 Topical preparations for acne 153 0.01 0.00 0.00 28.09
Ofloxacin 46 Antibacterials 178 0.26 0.01 0.03 8.53
Mepyramine maleate 4 Topical local anaesthetics and antipruritics 19 0.21 0.00 0.03 7.62
Galantamine 111 Drugs for dementia 432 0.26 0.03 0.06 3.83
Timolol 35 Beta-adrenoceptor blocking drugs 7,089 0.00 0.00 0.00 3.34
Piroxicam 22 Non-steroidal anti-inflammatory drugs 1,869 0.01 0.00 0.00 3.28
Olmesartan medoxomil/amlodipine/hydrochlorothiazide 31 Angiotensin-II receptor antagonists 3,120 0.01 0.00 0.00 3.25
Benzocaine 4 Drugs for oral ulceration and inflammation 78 0.05 0.00 0.02 3.21
Lithium citrate 14 Drugs used for mania and hypomania 159 0.09 0.01 0.03 3.14
Biphasic insulin lispro 180 Intermediate and long-acting insulins 832 0.22 0.05 0.06 2.94

Prescribing where Ashby Turn Primary Care Partners is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chloramphenicol 102 Antibacterials 178 0.57 0.81 0.11 -2.18
Docusate sodium 5 Stimulant laxatives 632 0.01 0.25 0.14 -1.76
Tacrolimus 19 Drugs affecting the immune response 40 0.48 0.81 0.19 -1.70
Clotrimazole 23 Antifungal preparations 147 0.16 0.43 0.16 -1.68
Sertraline hydrochloride 2,734 Selective serotonin re-uptake inhibitors 8,713 0.31 0.46 0.09 -1.66
Aciclovir 54 Herpes simplex and varicella-zoster 64 0.84 0.95 0.07 -1.66
Budesonide 128 Corticosteroids (respiratory) 3,915 0.03 0.15 0.08 -1.59
Ibuprofen 428 Rubefacients, topical NSAIDS, capsaicin and poultice 2,086 0.21 0.52 0.20 -1.55
Adapalene and benzoyl peroxide 1 Topical preparations for acne 153 0.01 0.16 0.10 -1.52
Colchicine 19 Gout and cytotoxic induced hyperiuicaemia 1,404 0.01 0.08 0.04 -1.49