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Prototype Prescribing Outlier Dashboard for Harvey Group 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 Harvey Group Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Formaldehyde 1 Preparations for warts and calluses 11 0.09 0.00 0.01 7.97
Flubiprofen 4 Drugs for oral ulceration and inflammation 45 0.09 0.00 0.01 7.68
Propafenone hydrochloride 39 Drugs for arrhythmias 121 0.32 0.02 0.05 5.70
Indometacin 96 Non-steroidal anti-inflammatory drugs 1,237 0.08 0.01 0.01 5.68
Carbomer 974P 13 Tear deficiency, eye lubricant/astringent 114 0.11 0.01 0.02 5.50
Cyproterone acetate 31 Prostate cancer and gonadorelin analogues 64 0.48 0.03 0.08 5.39
Other eczema preparations 1 Preparations for eczema 1 1.00 0.05 0.20 4.66
Paraffin soft white 6 Emollients 246 0.02 0.00 0.01 4.49
Triptorelin embonate 19 Prostate cancer and gonadorelin analogues 64 0.30 0.03 0.07 3.91
Risperidone 15 Antipsychotic depot injections 17 0.88 0.08 0.21 3.88

Prescribing where Harvey Group Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gamolenic acid 0 Preparations for eczema 1 0.00 0.90 0.30 -3.04
    Alginic acid compound preparations 337 Compound Alginates and proprietary indigestion preparations 349 0.97 1.00 0.01 -2.45
    Solifenacin 54 Drugs for urinary frequency enuresis and incontinence 767 0.07 0.33 0.11 -2.30
    Hydrocortisone 9 Copound haemorrhoidal preparations with corticosteroid 73 0.12 0.57 0.24 -1.83
    Codeine phosphate 2 Cough suppressants 12 0.17 0.74 0.33 -1.72
    Quinine sulfate 142 Antimalarials 212 0.67 0.90 0.14 -1.67
    Pizotifen malate 10 Prophylaxis of migraine 44 0.23 0.63 0.26 -1.57
    Cetirizine hydrochloride 195 Antihistamines 1,504 0.13 0.28 0.11 -1.42
    Beclometdiprop/formoterol/glycopyrronium 10 Selective beta(2)-agonists 1,969 0.01 0.06 0.04 -1.37
    Methylprednisolone acetate 14 Local corticosteroid injections 67 0.21 0.74 0.39 -1.35