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Prototype Prescribing Outlier Dashboard for Devonshire Green 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 Devonshire Green Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Mexiletine hydrochloride 10 Drugs for arrhythmias 20 0.50 0.00 0.01 50.07
Nefopam hydrochloride 463 Non-opioid analgesics and compound preparations 2,185 0.21 0.01 0.02 11.41
Hydrocortisone sodium succinate 10 Use of corticosteroids 430 0.02 0.00 0.00 8.40
Dronabinol/cannabidiol 5 Skeletal muscle relaxants 140 0.04 0.00 0.01 3.73
Valaciclovir 23 Herpes simplex and varicella-zoster 87 0.26 0.04 0.06 3.64
Insulin Lispro 69 Short-acting insulins 131 0.53 0.16 0.10 3.61
Clomifene citrate 1 Hypothalamic & anterior pituitary hormone & antioestrogens 1 1.00 0.09 0.26 3.52
Galantamine 83 Drugs for dementia 350 0.24 0.03 0.06 3.49
Levobunolol hydrochloride 4 Treatment of glaucoma 323 0.01 0.00 0.00 3.41
Dorzolamide and timolol 70 Treatment of glaucoma 323 0.22 0.09 0.04 3.09

Prescribing where Devonshire Green Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aciclovir 64 Herpes simplex and varicella-zoster 87 0.74 0.95 0.07 -3.28
Somatropin 0 Hypothalamic & anterior pituitary hormone & antioestrogens 1 0.00 0.90 0.28 -3.25
    Insulin aspart 62 Short-acting insulins 131 0.47 0.79 0.11 -2.81
    Prednisolone 322 Use of corticosteroids 430 0.75 0.89 0.06 -2.38
    Prucalopride 0 Other drugs used in constipation 1 0.00 0.71 0.32 -2.19
      Azathioprine 30 Antiproliferative immunosuppressants 75 0.40 0.80 0.19 -2.17
      Bendroflumethiazide 95 Thiazides and related diuretics 409 0.23 0.57 0.16 -2.14
      Venlafaxine 230 Other antidepressant drugs 2,863 0.08 0.26 0.09 -1.98
      Atropine sulfate 0 Mydriatics and cycloplegics 1 0.00 0.72 0.37 -1.93
        Brinzolamide 6 Treatment of glaucoma 323 0.02 0.09 0.04 -1.93