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Prototype Prescribing Outlier Dashboard for Essex Lodge

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 Essex Lodge is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Deferasirox 5 Hypoplastic/haemolytic and renal anaemias 5 1.00 0.02 0.13 7.52
Sulindac 6 Non-steroidal anti-inflammatory drugs 1,028 0.01 0.00 0.00 6.86
Pramipexole 27 Dopaminergic drugs used in parkinsonism 32 0.84 0.12 0.12 6.15
Rutosides 3 Peripheral vasodilators and related drugs 3 1.00 0.06 0.19 4.97
Captopril 51 Angiotensin-converting enzyme inhibitors 4,498 0.01 0.00 0.00 4.26
Paraffin soft white 27 Emollients 1,196 0.02 0.00 0.01 4.13
Trimipramine maleate 31 Tricyclic and related antidepressant drugs 1,791 0.02 0.00 0.00 3.92
Mefloquine hydrochloride 2 Antimalarials 277 0.01 0.00 0.00 3.84
INR blood testing reagents 16 Oral anticoagulants 1,422 0.01 0.00 0.00 3.60
Glucose 101 Foods for special diets 184 0.55 0.09 0.14 3.27

Prescribing where Essex Lodge is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-cyprindiol (Cyprote acetate/ethinylestradiol) 4 Oral preparations for acne 7 0.57 0.98 0.13 -3.22
Vitamin A 0 Vitamin A 1 0.00 0.82 0.36 -2.28
    Rifampicin 0 Antituberculosis drugs 21 0.00 0.74 0.40 -1.88
      Co-careldopa (Carbidopa/levodopa) 0 Dopaminergic drugs used in parkinsonism 32 0.00 0.33 0.18 -1.78
        Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 3 0.00 0.67 0.39 -1.73
          Macrogol 3350 463 Osmotic laxatives 856 0.54 0.71 0.10 -1.72
          Clotrimazole 26 Antifungal preparations 167 0.16 0.43 0.16 -1.69
          Flecainide acetate 3 Drugs for arrhythmias 72 0.04 0.46 0.25 -1.67
          Omeprazole 1,678 Proton pump inhibitors 7,239 0.23 0.50 0.16 -1.64
          Fluorouracil (Sunscreen) 0 Sunscreening preparations 2 0.00 0.45 0.29 -1.55