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Prototype Prescribing Outlier Dashboard for Kings Langley Surgery

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 Kings Langley Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Prilocaine hydrochloride 5 Local anaesthetics 206 0.02 0.00 0.00 31.28
Sodium clodronate 32 Bisphosphonates and other drugs 674 0.05 0.00 0.00 9.81
Ketotifen fumarate 12 Antihistamines 785 0.02 0.00 0.00 7.01
Zonisamide 107 Control of epilepsy 2,528 0.04 0.01 0.01 4.50
Paliperidone 8 Antipsychotic depot injections 8 1.00 0.09 0.22 4.13
Ciclosporin (Eye Anti Inflammatory) 33 Other anti-inflammatory preparations 89 0.37 0.07 0.08 3.72
Methocarbamol 113 Skeletal muscle relaxants 190 0.59 0.08 0.15 3.39
Oxcarbazepine 68 Control of epilepsy 2,528 0.03 0.00 0.01 3.36
Edoxaban 1,231 Oral anticoagulants 2,767 0.44 0.09 0.11 3.35
Insulin detemir 178 Intermediate and long-acting insulins 495 0.36 0.11 0.08 3.13

Prescribing where Kings Langley Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Acamprosate calcium 0 Alcohol dependence 21 0.00 0.83 0.31 -2.69
    Medroxyprogesterone acetate 37 Parenteral progestogen-only contraceptives 78 0.47 0.88 0.15 -2.65
    Sodium cromoglicate 14 Other anti-inflammatory preparations 89 0.16 0.64 0.19 -2.56
    Baclofen 74 Skeletal muscle relaxants 190 0.39 0.83 0.18 -2.42
    Oral rehydration salts 6 Oral sodium and water 77 0.08 0.71 0.29 -2.15
    Other emollient preparations 252 Emollients 339 0.74 0.89 0.07 -2.15
    Desogestrel 356 Oral progestogen-only contraceptives 428 0.83 0.93 0.05 -1.90
    Insulin glargine 44 Intermediate and long-acting insulins 495 0.09 0.33 0.13 -1.84
    Hydrocortisone 19 Copound haemorrhoidal preparations with corticosteroid 139 0.14 0.57 0.24 -1.78
    Hydrocortisone 297 Topical corticosteroids 1,232 0.24 0.34 0.06 -1.56