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Prototype Prescribing Outlier Dashboard for London Road Health 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 London Road Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenindione 3 Oral anticoagulants 2,085 0.00 0.00 0.00 11.12
Apomorphine hydrochloride hemihydrate 6 Dopaminergic drugs used in parkinsonism 408 0.01 0.00 0.00 8.84
Iron and folic acid 68 Oral iron 1,798 0.04 0.00 0.01 5.88
Diphenhydramine hydrochloride 55 Antihistamines 2,259 0.02 0.00 0.01 3.40
Testosterone undecanoate 54 Male sex hormones and antagonists 407 0.13 0.03 0.03 3.32
Bilastine 6 Antihistamines 2,259 0.00 0.00 0.00 3.28
Methylprednisolone 10 Use of corticosteroids 1,174 0.01 0.00 0.00 3.17
Calcitriol 28 Vitamin D 2,144 0.01 0.00 0.00 3.00
Naphazoline hydrochloride 6 Other anti-inflammatory preparations 361 0.02 0.00 0.01 2.97
Pantoprazole 696 Proton pump inhibitors 8,656 0.08 0.02 0.02 2.68

Prescribing where London Road Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Rivaroxaban 75 Oral anticoagulants 2,085 0.04 0.24 0.12 -1.71
Colecalciferol 1,977 Vitamin D 2,144 0.92 0.96 0.02 -1.69
Mometasone furoate 82 Drugs used in nasal allergy 824 0.10 0.32 0.13 -1.67
Alendronic acid 402 Bisphosphonates and other drugs 556 0.72 0.87 0.09 -1.62
Zopiclone 534 Hypnotics 1,399 0.38 0.60 0.14 -1.60
Finasteride 265 Male sex hormones and antagonists 407 0.65 0.82 0.11 -1.48
Insulin aspart 267 Short-acting insulins 426 0.63 0.79 0.11 -1.45
Furosemide 1,336 Loop diuretics 1,814 0.74 0.85 0.09 -1.32
Insulin glargine 155 Intermediate and long-acting insulins 987 0.16 0.33 0.13 -1.31
Umeclidinium bromide/vilanterol 19 Compound bronchodilator preparations 139 0.14 0.50 0.30 -1.23