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Prototype Prescribing Outlier Dashboard for Dr Shantir 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 Dr Shantir Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Alkyl sulfate 10 Shampoos and some other scalp preparations 76 0.13 0.00 0.01 20.82
Belladonna alkaloids 7 Antispasmodic and other drugs altering gut motility 80 0.09 0.00 0.01 13.39
Methylprednisolone 4 Use of corticosteroids 118 0.03 0.00 0.00 13.38
Torasemide 8 Loop diuretics 181 0.04 0.00 0.00 9.02
Chloramphenicol 1 Otitis externa 36 0.03 0.00 0.00 7.62
Oestrogens conjugated 28 Oestrogens and Hormone Replacement Therapy 82 0.34 0.04 0.04 6.91
Metoprolol tartrate 63 Beta-adrenoceptor blocking drugs 949 0.07 0.01 0.01 6.60
Perindopril arginine with diuretic 19 Angiotensin-converting enzyme inhibitors 1,238 0.02 0.00 0.00 6.46
Metformin hydrochloride/vildagliptin 37 Other antidiabetic drugs 692 0.05 0.00 0.01 6.40
Irbesartan with diuretic 36 Angiotensin-II receptor antagonists 751 0.05 0.00 0.01 6.20

Prescribing where Dr Shantir Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Isosorbide mononitrate 68 Nitrates 166 0.41 0.72 0.11 -2.91
Methylphenidate hydrochloride 6 CNS Stimulants and drugs used for ADHD 46 0.13 0.65 0.20 -2.54
Morphine sulfate 3 Opioid analgesics 370 0.01 0.20 0.08 -2.51
Clopidogrel 137 Antiplatelet drugs 742 0.18 0.32 0.06 -2.26
Bisoprolol fumarate 453 Beta-adrenoceptor blocking drugs 949 0.48 0.65 0.08 -2.23
Alginic acid compound preparations 98 Compound Alginates and proprietary indigestion preparations 101 0.97 1.00 0.01 -2.08
Neomycin sulfate 22 Nasal preparations for infection 39 0.56 0.84 0.14 -1.99
Atropine sulfate 0 Mydriatics and cycloplegics 1 0.00 0.72 0.37 -1.93
    Doxycycline hyclate 48 Tetracyclines 105 0.46 0.70 0.12 -1.91
    Estradiol 17 Oestrogens and Hormone Replacement Therapy 82 0.21 0.47 0.14 -1.89