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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Alverine citrate/simeticone 7 Antispasmodic and other drugs altering gut motility 641 0.01 0.00 0.00 7.74
Pilocarpine nitrate 9 Treatment of glaucoma 688 0.01 0.00 0.00 4.47
Dicycloverine hydrochloride compound preparations 27 Antispasmodic and other drugs altering gut motility 641 0.04 0.00 0.01 4.13
Bromocriptine 1 Bromocriptine and other dopaminergic drugs 1 1.00 0.10 0.23 3.87
Propamidine isetionate 1 Antibacterials 67 0.01 0.00 0.00 3.86
Atenolol 1,192 Beta-adrenoceptor blocking drugs 3,932 0.30 0.13 0.05 3.56
Pantoprazole 666 Proton pump inhibitors 6,924 0.10 0.02 0.02 3.40
Lormetazepam 8 Hypnotics 420 0.02 0.00 0.01 3.34
Estradiol and nomegestrol 3 Combined hormonal contraceptives 272 0.01 0.00 0.00 3.31
Ibandronic acid 43 Bisphosphonates and other drugs 350 0.12 0.02 0.03 3.02

Prescribing where Dunsville Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cabergoline 0 Bromocriptine and other dopaminergic drugs 1 0.00 0.86 0.27 -3.17
    Fusidic acid 18 Antibacterial preparations also used systemically 45 0.40 0.75 0.14 -2.46
    Tiotropium bromide 55 Antimuscarinic bronchodilators 196 0.28 0.71 0.18 -2.40
    Prucalopride 0 Other drugs used in constipation 2 0.00 0.71 0.32 -2.19
      Sertraline hydrochloride 1,046 Selective serotonin re-uptake inhibitors 3,866 0.27 0.46 0.09 -2.16
      Ivermectin 6 Topical preparation for rosacea 15 0.40 0.88 0.22 -2.15
      Quetiapine 27 Antipsychotic drugs 290 0.09 0.35 0.12 -2.11
      Bisoprolol fumarate 1,955 Beta-adrenoceptor blocking drugs 3,932 0.50 0.65 0.08 -1.97
      Calcipotriol 58 Preparations for psoriasis 80 0.72 0.87 0.08 -1.82
      Omeprazole 1,410 Proton pump inhibitors 6,924 0.20 0.50 0.16 -1.82