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Prototype Prescribing Outlier Dashboard for Grove Medical Practice

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 Grove Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ergotamine tartrate 2 Treatment of acute migraine 628 0.00 0.00 0.00 123.16
Other lozenge and spray preparations 2 Lozenges and sprays 2 1.00 0.01 0.07 13.90
Exenatide 78 Other antidiabetic drugs 1,839 0.04 0.00 0.01 4.30
Chlortalidone 42 Thiazides and related diuretics 2,547 0.02 0.00 0.00 4.17
Tropicamide 5 Mydriatics and cycloplegics 11 0.45 0.02 0.12 3.47
Dexamfetamine sulfate 37 CNS Stimulants and drugs used for ADHD 143 0.26 0.03 0.06 3.47
Indometacin 77 Non-steroidal anti-inflammatory drugs 1,531 0.05 0.01 0.01 3.41
Ketoconazole 23 Antifungal preparations 129 0.18 0.04 0.04 3.07
Cilostazol 16 Peripheral vasodilators and related drugs 17 0.94 0.12 0.27 3.04
Mebeverine hydrochloride compound preparations 28 Antispasmodic and other drugs altering gut motility 410 0.07 0.01 0.02 2.91

Prescribing where Grove Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Carbimazole 41 Antithyroid drugs 61 0.67 0.93 0.10 -2.51
Co-codamol (Codeine phosphate/paracetamol) 490 Non-opioid analgesics and compound preparations 3,447 0.14 0.45 0.15 -2.01
Ispaghula husk 164 Bulk-forming laxatives 198 0.83 0.96 0.07 -1.87
Apixaban 635 Oral anticoagulants 4,371 0.15 0.41 0.14 -1.86
Ramipril 3,744 Angiotensin-converting enzyme inhibitors 9,687 0.39 0.69 0.17 -1.86
Sodium chloride 0 Topical nasal decongestants 26 0.00 0.54 0.30 -1.79
    Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 17 0.00 0.67 0.39 -1.73
      Fusidic acid 72 Antibacterial preparations also used systemically 143 0.50 0.75 0.14 -1.72
      Sodium picosulfate 0 Bowel cleansing preparations 3 0.00 0.69 0.43 -1.61
        Tramadol hydrochloride 471 Opioid analgesics 3,368 0.14 0.27 0.09 -1.41