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Prototype Prescribing Outlier Dashboard for The Manor 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 The Manor Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Insulin human 2 Short-acting insulins 223 0.01 0.00 0.00 25.66
Levomepromazine hydrochloride 59 Antipsychotic drugs 738 0.08 0.01 0.02 4.40
Triptorelin embonate 24 Prostate cancer and gonadorelin analogues 75 0.32 0.03 0.07 4.24
Fidaxomicin 2 Some other antibacterials 40 0.05 0.00 0.01 3.55
Selenium sulfide 8 Shampoos and some other scalp preparations 44 0.18 0.03 0.04 3.36
Flupentixol hydrochloride 20 Antipsychotic drugs 738 0.03 0.00 0.01 2.91
Semaglutide 189 Other antidiabetic drugs 1,012 0.19 0.05 0.05 2.67
Metronidazole 42 Antibacterial preparations also used systemically 73 0.58 0.23 0.13 2.58
Dexamethasone sodium metasulphobenzoate 44 Otitis externa 262 0.17 0.04 0.05 2.27
Travoprost 139 Treatment of glaucoma 1,335 0.10 0.04 0.03 2.17

Prescribing where The Manor Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Fusidic acid 31 Antibacterial preparations also used systemically 73 0.42 0.75 0.14 -2.28
Amoxicillin 254 Broad-spectrum penicillins 357 0.71 0.85 0.07 -2.10
Ivermectin 3 Topical preparation for rosacea 7 0.43 0.88 0.22 -2.02
Hydrocortisone 316 Topical corticosteroids 1,394 0.23 0.34 0.06 -1.79
Insulin glargine 62 Intermediate and long-acting insulins 587 0.11 0.33 0.13 -1.71
Quinine sulfate 153 Antimalarials 229 0.67 0.90 0.14 -1.68
Hydrocortisone acetate 3 Topical corticosteroids 1,394 0.00 0.04 0.03 -1.55
Mupirocin 1 Antibacterial preparations only used topically 10 0.10 0.64 0.36 -1.51
Ticagrelor 3 Antiplatelet drugs 2,473 0.00 0.02 0.01 -1.40
Phytomenadione 0 Vitamin K 2 0.00 0.62 0.46 -1.35