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Prototype Prescribing Outlier Dashboard for Stansted 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 Stansted Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenobarbital sodium 1 Control of epilepsy 2,169 0.00 0.00 0.00 8.86
Titanium dioxide 1 Sunscreening preparations 42 0.02 0.00 0.00 5.23
Ketotifen fumarate 19 Antihistamines 1,840 0.01 0.00 0.00 4.65
Moxifloxacin hydrochloride 1 Ocular diagnostic & peri-operative prepn & photodynamic tt 2 0.50 0.03 0.11 4.50
Mometasone furoate 7 Corticosteroids (respiratory) 2,526 0.00 0.00 0.00 4.21
Other eye tear/lubricant/astringent preparations 16 Tear deficiency, eye lubricant/astringent 180 0.09 0.01 0.02 3.81
Hydrocortisone acetate 156 Topical corticosteroids 1,096 0.14 0.04 0.03 3.80
Sodium clodronate 8 Bisphosphonates and other drugs 551 0.01 0.00 0.00 2.83
Haloperidol decanoate 7 Antipsychotic depot injections 10 0.70 0.08 0.22 2.81
Fusidic acid 65 Antibacterials 231 0.28 0.08 0.08 2.72

Prescribing where Stansted Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glycopyrronium bromide 4 Antimuscarinic drugs 20 0.20 0.82 0.35 -1.77
Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 12 0.00 0.67 0.39 -1.73
    Tacrolimus 35 Drugs affecting the immune response 74 0.47 0.81 0.19 -1.72
    Sertraline hydrochloride 1,608 Selective serotonin re-uptake inhibitors 5,108 0.31 0.46 0.09 -1.65
    Sumatriptan succinate 148 Treatment of acute migraine 310 0.48 0.67 0.12 -1.60
    Hydrocortisone 262 Topical corticosteroids 1,096 0.24 0.34 0.06 -1.59
    Cyclizine hydrochloride 36 Drugs used in nausea and vertigo 661 0.05 0.17 0.07 -1.56
    Ferrous fumarate 186 Oral iron 870 0.21 0.57 0.23 -1.52
    Theophylline 35 Theophylline 52 0.67 0.91 0.17 -1.45
    Zinc oxide 8 Barrier preparations 324 0.02 0.49 0.33 -1.42