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Prototype Prescribing Outlier Dashboard for Springs Health 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 Springs Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Strontium ranelate 8 Bisphosphonates and other drugs 666 0.01 0.00 0.00 7.69
Azelastine hydrochloride 32 Other anti-inflammatory preparations 61 0.52 0.06 0.08 6.16
Cefradine 29 Cephalosporins 60 0.48 0.02 0.08 5.81
Isotretinoin 8 Oral preparations for acne 11 0.73 0.02 0.13 5.60
Atenolol 2,144 Beta-adrenoceptor blocking drugs 6,330 0.34 0.13 0.05 4.28
Adapalene 46 Topical preparations for acne 118 0.39 0.11 0.07 4.02
Formoterol fumarate 119 Selective beta(2)-agonists 4,816 0.02 0.00 0.01 3.52
Ipratropium bromide 329 Antimuscarinic bronchodilators 1,191 0.28 0.07 0.06 3.28
Biphasic isophane insulin 480 Intermediate and long-acting insulins 995 0.48 0.13 0.11 3.18
Nadolol 20 Beta-adrenoceptor blocking drugs 6,330 0.00 0.00 0.00 2.97

Prescribing where Springs Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-cyprindiol (Cyprote acetate/ethinylestradiol) 3 Oral preparations for acne 11 0.27 0.98 0.13 -5.60
Cefalexin 31 Cephalosporins 60 0.52 0.96 0.10 -4.64
Bisoprolol fumarate 2,706 Beta-adrenoceptor blocking drugs 6,330 0.43 0.65 0.08 -2.86
Midazolam hydrochloride 0 Drugs used in status epilepticus 4 0.00 0.80 0.28 -2.82
    Indapamide 124 Thiazides and related diuretics 2,396 0.05 0.43 0.16 -2.38
    Estradiol 14 Preparations for vaginal/vulval changes 180 0.08 0.55 0.20 -2.28
    Co-codamol (Codeine phosphate/paracetamol) 683 Non-opioid analgesics and compound preparations 4,531 0.15 0.45 0.15 -1.96
    Acamprosate calcium 14 Alcohol dependence 60 0.23 0.83 0.31 -1.93
    Methylprednisolone acetate 0 Local corticosteroid injections 64 0.00 0.74 0.39 -1.89
      Ketoconazole 28 Shampoos and some other scalp preparations 123 0.23 0.50 0.15 -1.77