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Prototype Prescribing Outlier Dashboard for Seven Dials Medical Centre

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 Seven Dials Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aspirin combined preparations 9 Non-opioid analgesics and compound preparations 1,661 0.01 0.00 0.00 272.83
Flunarizine dihydrochloride 7 Drugs used in nausea and vertigo 399 0.02 0.00 0.00 11.29
Triamterene with loop diuretics 2 Potassium sparing diuretics and compounds 3 0.67 0.01 0.07 9.38
Pilocarpine nitrate 9 Treatment of glaucoma 408 0.02 0.00 0.00 7.71
Brivaracetam 56 Control of epilepsy 1,901 0.03 0.00 0.00 7.30
Gluten free/low protein biscuits 3 Foods for special diets 37 0.08 0.00 0.01 6.82
Zuclopenthixol hydrochloride 102 Antipsychotic drugs 1,028 0.10 0.01 0.01 6.51
Nedocromil sodium 1 Cromoglycate and related therapy 1 1.00 0.03 0.15 6.42
Low protein biscuits 3 Foods for special diets 37 0.08 0.00 0.02 4.98
Betaxolol 9 Treatment of glaucoma 408 0.02 0.00 0.00 4.77

Prescribing where Seven Dials Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium cromoglicate 0 Cromoglycate and related therapy 1 0.00 0.97 0.15 -6.42
    Other multivitamin preparations 96 Multivitamin preparations 652 0.15 0.82 0.21 -3.27
    Mebeverine hydrochloride 20 Antispasmodic and other drugs altering gut motility 207 0.10 0.45 0.12 -2.85
    Alginic acid compound preparations 155 Compound Alginates and proprietary indigestion preparations 161 0.96 1.00 0.01 -2.68
    Medroxyprogesterone acetate 6 Parenteral progestogen-only contraceptives 12 0.50 0.88 0.15 -2.49
    Benzydamine hydrochloride 13 Drugs for oral ulceration and inflammation 27 0.48 0.84 0.16 -2.27
    Finasteride 93 Male sex hormones and antagonists 163 0.57 0.82 0.11 -2.18
    Fluconazole 22 Triazole antifungals 39 0.56 0.85 0.13 -2.16
    Furosemide 557 Loop diuretics 841 0.66 0.85 0.09 -2.15
    Co-amilofruse (Amiloride hydrochloride/frusemide) 0 Potassium sparing diuretics and compounds 3 0.00 0.69 0.33 -2.10