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Prototype Prescribing Outlier Dashboard for High Street 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 High Street Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Posaconazole 5 Triazole antifungals 25 0.20 0.00 0.01 31.63
Baricitinib 2 Rheumatic disease suppressant drugs 393 0.01 0.00 0.00 15.49
Amiloride hydrochloride with loop diuretics 6 Potassium sparing diuretics and compounds 6 1.00 0.02 0.08 12.10
Linagliptin/metformin 252 Other antidiabetic drugs 2,079 0.12 0.00 0.01 9.35
Phenoxybenzamine hydrochloride 4 Alpha-adrenoceptor blocking drugs 514 0.01 0.00 0.00 8.86
Pentosan polysulfate sodium 6 Oral anticoagulants 1,784 0.00 0.00 0.00 8.38
Pantoprazole 1,313 Proton pump inhibitors 8,638 0.15 0.02 0.02 5.95
Salmeterol 211 Selective beta(2)-agonists 3,155 0.07 0.01 0.01 5.49
Nefopam hydrochloride 546 Non-opioid analgesics and compound preparations 5,470 0.10 0.01 0.02 5.11
Quinapril hydrochloride 16 Angiotensin-converting enzyme inhibitors 5,209 0.00 0.00 0.00 4.44

Prescribing where High Street Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Procyclidine hydrochloride 0 Antimuscarinic drugs used in parkinsonism 6 0.00 0.85 0.21 -4.10
    Losartan potassium 110 Angiotensin-II receptor antagonists 2,220 0.05 0.50 0.19 -2.43
    Glycopyrronium bromide 0 Antimuscarinic drugs 7 0.00 0.82 0.35 -2.34
      Alendronic acid 525 Bisphosphonates and other drugs 778 0.67 0.87 0.09 -2.14
      Co-amilofruse (Amiloride hydrochloride/frusemide) 0 Potassium sparing diuretics and compounds 6 0.00 0.69 0.33 -2.10
        Senna 279 Stimulant laxatives 1,048 0.27 0.55 0.14 -2.06
        Ivermectin 1 Topical preparation for rosacea 2 0.50 0.88 0.22 -1.70
        Citalopram hydrobromide 923 Selective serotonin re-uptake inhibitors 5,213 0.18 0.32 0.08 -1.68
        Insulin glargine 51 Intermediate and long-acting insulins 452 0.11 0.33 0.13 -1.65
        Tramadol hydrochloride 301 Opioid analgesics 2,507 0.12 0.27 0.09 -1.63