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Prototype Prescribing Outlier Dashboard for Dr S Shafi

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 Dr S Shafi is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lurasidone 25 Antipsychotic drugs 88 0.28 0.00 0.01 37.78
Eslicarbazepine acetate 56 Control of epilepsy 616 0.09 0.00 0.00 32.54
Deflazacort 8 Use of corticosteroids 86 0.09 0.00 0.00 27.46
Oestrogens conjugated 5 Oestrogens and Hormone Replacement Therapy 5 1.00 0.04 0.04 21.94
Fluocinonide 5 Topical corticosteroids 127 0.04 0.00 0.00 14.72
Safinamide 41 Dopaminergic drugs used in parkinsonism 181 0.23 0.00 0.02 14.67
Vardenafil 20 Drugs for erectile dysfunction 67 0.30 0.02 0.02 13.74
Famciclovir 1 Herpes simplex and varicella-zoster 4 0.25 0.01 0.02 12.39
Analgesics with anti-emetics 8 Treatment of acute migraine 14 0.57 0.04 0.05 10.59
Zolpidem tartrate 42 Hypnotics 57 0.74 0.07 0.07 9.94

Prescribing where Dr S Shafi is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Neomycin sulfate 3 Nasal preparations for infection 11 0.27 0.84 0.14 -4.13
Estradiol 0 Oestrogens and Hormone Replacement Therapy 5 0.00 0.47 0.14 -3.37
    Estradiol with progestogen 0 Oestrogens and Hormone Replacement Therapy 5 0.00 0.39 0.12 -3.29
      Influenza 0 Vaccines and antisera 1 0.00 0.88 0.28 -3.13
        Aciclovir 3 Herpes simplex and varicella-zoster 4 0.75 0.95 0.07 -3.06
        Lidocaine hydrochloride 10 Local anaesthetics 19 0.53 0.90 0.13 -2.81
        Benzoyl peroxide and clindamycin phosphate 0 Topical preparations for acne 6 0.00 0.38 0.13 -2.79
          Benzydamine hydrochloride 2 Drugs for oral ulceration and inflammation 5 0.40 0.84 0.16 -2.77
          Desogestrel 16 Oral progestogen-only contraceptives 20 0.80 0.93 0.05 -2.49
          Zopiclone 15 Hypnotics 57 0.26 0.60 0.14 -2.46