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Prototype Prescribing Outlier Dashboard for Wickham Park 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 Wickham Park Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Saxagliptin/metformin 21 Other antidiabetic drugs 440 0.05 0.00 0.00 15.57
Carbomer 974P 16 Tear deficiency, eye lubricant/astringent 78 0.21 0.01 0.02 10.27
Enalapril maleate with diuretic 12 Angiotensin-converting enzyme inhibitors 1,422 0.01 0.00 0.00 9.64
Mycophenolic sodium 8 Antiproliferative immunosuppressants 41 0.20 0.01 0.03 7.37
Metformin hydrochloride/sitagliptin 81 Other antidiabetic drugs 440 0.18 0.01 0.03 6.65
Diclofenac sodium 11 Ocular diagnostic & peri-operative prepn & photodynamic tt 14 0.79 0.03 0.12 6.10
Dequalinium chloride 1 Vaginal and vulval infections 37 0.03 0.00 0.01 5.11
Acebutolol hydrochloride 4 Beta-adrenoceptor blocking drugs 1,380 0.00 0.00 0.00 4.81
Dapagliflozin/metformin 25 Other antidiabetic drugs 440 0.06 0.00 0.01 4.77
Ramipril with calcium channel blocker 4 Angiotensin-converting enzyme inhibitors 1,422 0.00 0.00 0.00 4.21

Prescribing where Wickham Park Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amiodarone hydrochloride 0 Drugs for arrhythmias 26 0.00 0.48 0.25 -1.89
    Carbomer 940/980 5 Tear deficiency, eye lubricant/astringent 78 0.06 0.34 0.15 -1.86
    Emollient bath and shower preparations 1 Emollient bath and shower preparations 4 0.25 0.63 0.21 -1.80
    Sildenafil (Erectile Dysfunction) 100 Drugs for erectile dysfunction 166 0.60 0.77 0.09 -1.78
    Calcipotriol 31 Preparations for psoriasis 42 0.74 0.87 0.08 -1.66
    Zinc sulfate monohydrate 1 Zinc 10 0.10 0.74 0.39 -1.64
    Duloxetine hydrochloride 16 Other antidepressant drugs 471 0.03 0.15 0.07 -1.63
    Methylphenidate hydrochloride 37 CNS Stimulants and drugs used for ADHD 113 0.33 0.65 0.20 -1.58
    Apixaban 221 Oral anticoagulants 1,180 0.19 0.41 0.14 -1.57
    Oral rehydration salts 6 Oral sodium and water 24 0.25 0.71 0.29 -1.56