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Prototype Prescribing Outlier Dashboard for Monkfield 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 Monkfield Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydrogen peroxide 2 Mouth-washes, gargles and dentifrices 3 0.67 0.01 0.06 11.81
Paracetamol combined preparations 6 Non-opioid analgesics and compound preparations 870 0.01 0.00 0.00 9.88
Diclofenac sodium 5 Ocular diagnostic & peri-operative prepn & photodynamic tt 7 0.71 0.03 0.12 5.52
Other psoriasis preparations 2 Preparations for psoriasis 94 0.02 0.00 0.00 4.87
Hepatitis A 9 Vaccines and antisera 36 0.25 0.01 0.06 3.93
Diltiazem hydrochloride 1 Soothing haemorrhoidal preparations 1 1.00 0.15 0.22 3.91
Colestyramine 25 Lipid-regulating drugs 3,254 0.01 0.00 0.00 3.91
Chlortalidone 8 Thiazides and related diuretics 521 0.02 0.00 0.00 3.86
Testosterone 53 Male sex hormones and antagonists 176 0.30 0.07 0.06 3.81
Diphtheria 12 Vaccines and antisera 36 0.33 0.02 0.08 3.77

Prescribing where Monkfield Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine gluconate 1 Mouth-washes, gargles and dentifrices 3 0.33 0.97 0.11 -6.02
Influenza 0 Vaccines and antisera 36 0.00 0.88 0.28 -3.13
    Zinc oxide 0 Soothing haemorrhoidal preparations 1 0.00 0.77 0.26 -3.01
      Alginic acid compound preparations 194 Compound Alginates and proprietary indigestion preparations 201 0.97 1.00 0.01 -2.49
      Finasteride 105 Male sex hormones and antagonists 176 0.60 0.82 0.11 -1.95
      Ispaghula husk 25 Bulk-forming laxatives 30 0.83 0.96 0.07 -1.80
      Glucose blood testing reagents 418 Diabetic diagnostic and monitoring agents 474 0.88 0.94 0.03 -1.78
      Tramadol hydrochloride 153 Opioid analgesics 1,429 0.11 0.27 0.09 -1.77
      Ramipril 848 Angiotensin-converting enzyme inhibitors 2,084 0.41 0.69 0.17 -1.73
      Gliclazide 134 Sulfonylureas 190 0.71 0.93 0.13 -1.64