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Prototype Prescribing Outlier Dashboard for Ashbourne Medical Practice

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 Ashbourne Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Castor oil 7 Stimulant laxatives 913 0.01 0.00 0.00 231.78
Lixisenatide 65 Other antidiabetic drugs 1,514 0.04 0.00 0.01 7.53
Rupatadine fumarate 5 Antihistamines 882 0.01 0.00 0.00 5.83
Phentolamine/aviptadil 10 Drugs for erectile dysfunction 548 0.02 0.00 0.00 4.26
Diltiazem hydrochloride 2 Soothing haemorrhoidal preparations 2 1.00 0.15 0.22 3.91
Timolol 24 Beta-adrenoceptor blocking drugs 4,301 0.01 0.00 0.00 3.80
Famciclovir 7 Herpes simplex and varicella-zoster 91 0.08 0.01 0.02 3.62
Sotalol hydrochloride 191 Beta-adrenoceptor blocking drugs 4,301 0.04 0.01 0.01 3.56
Edoxaban 979 Oral anticoagulants 2,192 0.45 0.09 0.11 3.36
Methyldopa 16 Centrally-acting antihypertensive drugs 16 1.00 0.16 0.26 3.28

Prescribing where Ashbourne Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Zinc oxide 0 Soothing haemorrhoidal preparations 2 0.00 0.77 0.26 -3.01
    Procyclidine hydrochloride 10 Antimuscarinic drugs used in parkinsonism 44 0.23 0.85 0.21 -3.00
    Acamprosate calcium 0 Alcohol dependence 9 0.00 0.83 0.31 -2.69
      Quinine sulfate 104 Antimalarials 173 0.60 0.90 0.14 -2.17
      Glucose blood testing reagents 490 Diabetic diagnostic and monitoring agents 563 0.87 0.94 0.03 -2.12
      Nicotine 0 Nicotine dependence 10 0.00 0.65 0.33 -1.95
        Moxonidine 0 Centrally-acting antihypertensive drugs 16 0.00 0.65 0.33 -1.95
          Senna 267 Stimulant laxatives 913 0.29 0.55 0.14 -1.87
          Letrozole 21 Breast cancer 274 0.08 0.45 0.22 -1.71
          Salbutamol 1,438 Selective beta(2)-agonists 1,728 0.83 0.91 0.04 -1.67