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Prototype Prescribing Outlier Dashboard for Dr Dv Shah'S 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 Dr Dv Shah'S Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ciprofloxacin/fluocinolone 7 Otitis externa 43 0.16 0.00 0.01 19.58
Phenobarbital sodium 1 Control of epilepsy 1,123 0.00 0.00 0.00 17.20
Miconazole nitrate 9 Vaginal and vulval infections 34 0.26 0.01 0.03 7.38
Hyoscine hydrobromide 38 Drugs used in nausea and vertigo 189 0.20 0.02 0.03 5.53
Meptazinol hydrochloride 21 Opioid analgesics 384 0.05 0.00 0.01 4.94
Phenytoin sodium 108 Control of epilepsy 1,123 0.10 0.02 0.02 4.84
Fluvastatin sodium 36 Lipid-regulating drugs 3,854 0.01 0.00 0.00 4.15
Lidocaine hydrochloride 4 Soothing haemorrhoidal preparations 6 0.67 0.06 0.15 4.10
Mirabegron 143 Drugs for urinary frequency enuresis and incontinence 249 0.57 0.23 0.09 3.84
Azelastine hydrochloride 17 Other anti-inflammatory preparations 49 0.35 0.06 0.08 3.82

Prescribing where Dr Dv Shah'S Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Estradiol with progestogen 3 Oestrogens and Hormone Replacement Therapy 61 0.05 0.39 0.12 -2.88
Clotrimazole 23 Vaginal and vulval infections 34 0.68 0.90 0.09 -2.63
Emollient bath and shower preparations 5 Emollient bath and shower preparations 44 0.11 0.63 0.21 -2.44
Tamsulosin hydrochloride 170 Drugs for urinary retention 219 0.78 0.92 0.06 -2.41
Mebeverine hydrochloride 22 Antispasmodic and other drugs altering gut motility 129 0.17 0.45 0.12 -2.26
Pregabalin 110 Control of epilepsy 1,123 0.10 0.27 0.08 -2.19
Prednisolone 210 Use of corticosteroids 276 0.76 0.89 0.06 -2.18
Permethrin 1 Parasiticidal preparations 3 0.33 0.83 0.24 -2.07
Tamoxifen citrate 0 Breast cancer 86 0.00 0.27 0.14 -1.99
    Citalopram hydrobromide 157 Selective serotonin re-uptake inhibitors 1,032 0.15 0.32 0.08 -1.98