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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sulindac 6 Non-steroidal anti-inflammatory drugs 902 0.01 0.00 0.00 7.83
Ferrous gluconate 243 Oral iron 642 0.38 0.03 0.05 6.58
Dornase alfa 7 Mucolytics 121 0.06 0.00 0.01 5.84
Calcium acetate/magnesium carbonate 6 Phosphate binding agents 6 1.00 0.05 0.18 5.35
Prochlorperazine mesilate 10 Drugs used in nausea and vertigo 517 0.02 0.00 0.00 4.16
Rosuvastatin calcium 1,044 Lipid-regulating drugs 9,118 0.11 0.04 0.02 3.15
Other eye tear/lubricant/astringent preparations 13 Tear deficiency, eye lubricant/astringent 174 0.07 0.01 0.02 3.12
Tacalcitol 5 Preparations for psoriasis 95 0.05 0.00 0.02 3.04
Rufinamide 14 Control of epilepsy 2,772 0.01 0.00 0.00 3.04
Deflazacort 8 Use of corticosteroids 738 0.01 0.00 0.00 3.02

Prescribing where Hamstreet Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amoxicillin 348 Broad-spectrum penicillins 528 0.66 0.85 0.07 -2.87
Furosemide 577 Loop diuretics 913 0.63 0.85 0.09 -2.49
Nitrofurantoin 293 Urinary-tract infections 358 0.82 0.96 0.06 -2.47
Losartan potassium 414 Angiotensin-II receptor antagonists 3,602 0.11 0.50 0.19 -2.08
Ferrous fumarate 66 Oral iron 642 0.10 0.57 0.23 -2.00
Doxycycline hyclate 154 Tetracyclines 343 0.45 0.70 0.12 -1.98
Carbomer 940/980 10 Tear deficiency, eye lubricant/astringent 174 0.06 0.34 0.15 -1.90
Pizotifen malate 8 Prophylaxis of migraine 50 0.16 0.63 0.26 -1.83
Mirtazapine 469 Other antidepressant drugs 1,230 0.38 0.57 0.10 -1.77
Donepezil hydrochloride 12 Drugs for dementia 69 0.17 0.49 0.18 -1.72