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Prototype Prescribing Outlier Dashboard for Forest 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 Forest Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Vildagliptin 136 Other antidiabetic drugs 858 0.16 0.00 0.01 18.33
Sodium fusidate 11 Some other antibacterials 23 0.48 0.01 0.06 7.25
Cyproheptadine hydrochloride 6 Antihistamines 1,222 0.00 0.00 0.00 3.91
Erdosteine 11 Mucolytics 259 0.04 0.00 0.01 3.50
Degarelix 16 Prostate cancer and gonadorelin analogues 56 0.29 0.03 0.07 3.47
Reboxetine 16 Other antidepressant drugs 1,274 0.01 0.00 0.00 3.27
Lidocaine 6 Topical local anaesthetics and antipruritics 12 0.50 0.08 0.14 2.99
Amiloride hydrochloride with loop diuretics 4 Potassium sparing diuretics and compounds 17 0.24 0.02 0.08 2.70
Ciprofloxain/dexameth 70 Otitis externa 313 0.22 0.05 0.06 2.64
Brinzolamide and timolol 58 Treatment of glaucoma 826 0.07 0.02 0.02 2.55

Prescribing where Forest Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Codeine phosphate 0 Cough suppressants 1 0.00 0.74 0.33 -2.22
    Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 6 0.00 0.67 0.39 -1.73
      Isosorbide mononitrate 222 Nitrates 406 0.55 0.72 0.11 -1.62
      Pizotifen malate 14 Prophylaxis of migraine 54 0.26 0.63 0.26 -1.44
      Carbomer 940/980 22 Tear deficiency, eye lubricant/astringent 170 0.13 0.34 0.15 -1.41
      Lidocaine hydrochloride 30 Local anaesthetics 42 0.71 0.90 0.13 -1.41
      Sodium chloride 2 Topical nasal decongestants 15 0.13 0.54 0.30 -1.35
      Morphine sulfate 172 Opioid analgesics 1,743 0.10 0.20 0.08 -1.35
      Prednisolone 13 Copound haemorrhoidal preparations with corticosteroid 116 0.11 0.43 0.24 -1.33
      Beclometdiprop/formoterol/glycopyrronium 19 Selective beta(2)-agonists 2,390 0.01 0.06 0.04 -1.30