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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Formaldehyde 1 Preparations for warts and calluses 4 0.25 0.00 0.01 22.05
Fluvoxamine maleate 45 Selective serotonin re-uptake inhibitors 2,379 0.02 0.00 0.00 9.92
Levomepromazine maleate 41 Antipsychotic drugs 847 0.05 0.00 0.01 6.20
Cefaclor 3 Cephalosporins 23 0.13 0.01 0.03 4.41
Paraffin soft white 9 Emollients 380 0.02 0.00 0.01 4.35
Gemfibrozil 8 Lipid-regulating drugs 5,073 0.00 0.00 0.00 4.24
Ibandronic acid 37 Bisphosphonates and other drugs 230 0.16 0.02 0.03 4.19
Empagliflozin 798 Other antidiabetic drugs 1,444 0.55 0.15 0.10 4.06
Cocois 33 Preparations for psoriasis 124 0.27 0.06 0.06 3.63
Ticagrelor 134 Antiplatelet drugs 2,328 0.06 0.02 0.01 3.31

Prescribing where Upwell Street Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
    Aciclovir 37 Herpes simplex and varicella-zoster 47 0.79 0.95 0.07 -2.50
    Estradiol 10 Preparations for vaginal/vulval changes 105 0.10 0.55 0.20 -2.20
    Co-amilofruse (Amiloride hydrochloride/frusemide) 0 Potassium sparing diuretics and compounds 16 0.00 0.69 0.33 -2.10
      Insulin glargine 31 Intermediate and long-acting insulins 505 0.06 0.33 0.13 -2.05
      Methotrexate 29 Rheumatic disease suppressant drugs 100 0.29 0.58 0.15 -1.85
      Flecainide acetate 0 Drugs for arrhythmias 8 0.00 0.46 0.25 -1.84
        Citalopram hydrobromide 391 Selective serotonin re-uptake inhibitors 2,379 0.16 0.32 0.08 -1.84
        Insulin aspart 70 Short-acting insulins 120 0.58 0.79 0.11 -1.83
        Venlafaxine 124 Other antidepressant drugs 1,312 0.09 0.26 0.09 -1.82