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Prototype Prescribing Outlier Dashboard for Oakwood 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 Oakwood Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hyoscine hydrobromide 32 Drugs used in nausea and vertigo 123 0.26 0.02 0.03 7.32
Dexamethasone 38 Use of corticosteroids 229 0.17 0.03 0.02 6.15
Ranitidine hydrochloride 7 H2-Receptor antagonists 17 0.41 0.02 0.08 4.91
Adapalene and benzoyl peroxide 55 Topical preparations for acne 94 0.59 0.16 0.10 4.21
Oxazepam 8 Anxiolytics 75 0.11 0.01 0.02 4.18
Citalopram hydrochloride 16 Selective serotonin re-uptake inhibitors 1,504 0.01 0.00 0.00 4.11
Nitrazepam 32 Hypnotics 147 0.22 0.04 0.05 3.78
Frovatriptan 10 Treatment of acute migraine 79 0.13 0.02 0.03 3.73
Isosorbide dinitrate 31 Nitrates 291 0.11 0.01 0.03 3.70
Ciclesonide 10 Corticosteroids (respiratory) 597 0.02 0.00 0.00 3.66

Prescribing where Oakwood Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Prednisolone 158 Use of corticosteroids 229 0.69 0.89 0.06 -3.40
Allopurinol 254 Gout and cytotoxic induced hyperiuicaemia 333 0.76 0.90 0.05 -2.59
Simvastatin 119 Lipid-regulating drugs 4,259 0.03 0.22 0.07 -2.53
Combined ethinylestradiol 30mcg 64 Combined hormonal contraceptives 101 0.63 0.81 0.07 -2.45
Sulfasalazine 0 Aminosalicylates 67 0.00 0.33 0.14 -2.33
    Betahistine hydrochloride 3 Drugs used in nausea and vertigo 123 0.02 0.27 0.11 -2.24
    Fusidic acid 18 Antibacterial preparations also used systemically 40 0.45 0.75 0.14 -2.10
    Methylphenidate hydrochloride 19 CNS Stimulants and drugs used for ADHD 81 0.23 0.65 0.20 -2.03
    Lamotrigine 29 Control of epilepsy 978 0.03 0.11 0.04 -1.98
    Citalopram hydrobromide 230 Selective serotonin re-uptake inhibitors 1,504 0.15 0.32 0.08 -1.97