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Prototype Prescribing Outlier Dashboard for The Fryent Way 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 The Fryent Way Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Levonorgestrel 7 Oral progestogen-only contraceptives 56 0.12 0.01 0.02 6.63
Imipramine hydrochloride 39 Tricyclic and related antidepressant drugs 616 0.06 0.01 0.01 5.66
Belladonna alkaloids 7 Antispasmodic and other drugs altering gut motility 209 0.03 0.00 0.01 5.06
Chlordiazepoxide hydrochloride 10 Anxiolytics 146 0.07 0.01 0.02 4.05
Acarbose 32 Other antidiabetic drugs 1,619 0.02 0.00 0.00 3.77
Emulsifying wax 48 Emollients 404 0.12 0.01 0.03 3.67
Salbutamol 9 Compound bronchodilator preparations 36 0.25 0.01 0.07 3.60
Phenytoin sodium 108 Control of epilepsy 1,425 0.08 0.02 0.02 3.56
Dextromethorphan hydrobromide 1 Cough suppressants 4 0.25 0.01 0.07 3.55
Betamethasone sodium phosphate 13 Use of corticosteroids 334 0.04 0.01 0.01 3.50

Prescribing where The Fryent Way Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Desogestrel 38 Oral progestogen-only contraceptives 56 0.68 0.93 0.05 -4.73
Ispaghula husk 41 Bulk-forming laxatives 53 0.77 0.96 0.07 -2.62
Theophylline 12 Theophylline 21 0.57 0.91 0.17 -2.06
Lamotrigine 41 Control of epilepsy 1,425 0.03 0.11 0.04 -2.00
Moxonidine 0 Centrally-acting antihypertensive drugs 16 0.00 0.65 0.33 -1.95
    Estradiol 17 Preparations for vaginal/vulval changes 106 0.16 0.55 0.20 -1.88
    Rifampicin 0 Antituberculosis drugs 6 0.00 0.74 0.40 -1.88
      Azathioprine 56 Antiproliferative immunosuppressants 121 0.46 0.80 0.19 -1.83
      Other emollient preparations 313 Emollients 404 0.77 0.89 0.07 -1.69
      Propranolol hydrochloride 89 Beta-adrenoceptor blocking drugs 2,353 0.04 0.16 0.08 -1.67