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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lixisenatide 19 Other antidiabetic drugs 268 0.07 0.00 0.01 12.65
Testosterone undecanoate 19 Male sex hormones and antagonists 69 0.28 0.03 0.03 7.97
Fosinopril sodium 4 Angiotensin-converting enzyme inhibitors 1,224 0.00 0.00 0.00 7.38
Raloxifene hydrochloride 33 Oestrogens and Hormone Replacement Therapy 171 0.19 0.01 0.03 7.09
Dipyridamole 43 Antiplatelet drugs 872 0.05 0.01 0.01 7.03
Hyetellose 7 Tear deficiency, eye lubricant/astringent 64 0.11 0.01 0.01 7.01
Degarelix 7 Prostate cancer and gonadorelin analogues 15 0.47 0.03 0.07 5.92
Benzalkonium chloride 10 Barrier preparations 12 0.83 0.05 0.14 5.58
Acebutolol hydrochloride 4 Beta-adrenoceptor blocking drugs 1,343 0.00 0.00 0.00 4.95
Tafluprost and timolol 7 Treatment of glaucoma 178 0.04 0.00 0.01 4.61

Prescribing where Derwent Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Quinine sulfate 29 Antimalarials 80 0.36 0.90 0.14 -3.93
Finasteride 29 Male sex hormones and antagonists 69 0.42 0.82 0.11 -3.50
Permethrin 0 Parasiticidal preparations 1 0.00 0.83 0.24 -3.46
    Fluconazole 4 Triazole antifungals 8 0.50 0.85 0.13 -2.63
    Glucose blood testing reagents 178 Diabetic diagnostic and monitoring agents 206 0.86 0.94 0.03 -2.31
    Ketoconazole 3 Shampoos and some other scalp preparations 20 0.15 0.50 0.15 -2.28
    Codeine phosphate 0 Cough suppressants 1 0.00 0.74 0.33 -2.22
      Prucalopride 0 Other drugs used in constipation 3 0.00 0.71 0.32 -2.19
        Donepezil hydrochloride 6 Drugs for dementia 54 0.11 0.49 0.18 -2.06
        Moxonidine 0 Centrally-acting antihypertensive drugs 1 0.00 0.65 0.33 -1.95