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Prototype Prescribing Outlier Dashboard for Church Street 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 Church Street Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pethidine hydrochloride 17 Opioid analgesics 1,071 0.02 0.00 0.00 7.99
Fluocortolone 6 Copound haemorrhoidal preparations with corticosteroid 194 0.03 0.00 0.00 6.79
Trifluoperazine 32 Antipsychotic drugs 711 0.05 0.00 0.01 5.54
Magnesium oxide 6 Antacids and simeticone 6 1.00 0.05 0.18 5.23
Indometacin 61 Non-steroidal anti-inflammatory drugs 868 0.07 0.01 0.01 5.07
Dexamethasone sodium metasulphobenzoate 45 Otitis externa 153 0.29 0.04 0.05 4.58
Canagliflozin/metformin 16 Other antidiabetic drugs 837 0.02 0.00 0.00 4.54
Semaglutide 219 Other antidiabetic drugs 837 0.26 0.05 0.05 4.12
Minoxidil 4 Shampoos and some other scalp preparations 81 0.05 0.00 0.01 3.99
Alprostadil 43 Drugs for erectile dysfunction 393 0.11 0.02 0.02 3.72

Prescribing where Church Street Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Medroxyprogesterone acetate 10 Parenteral progestogen-only contraceptives 24 0.42 0.88 0.15 -3.03
Sildenafil (Erectile Dysfunction) 218 Drugs for erectile dysfunction 393 0.55 0.77 0.09 -2.31
Dexamethasone 85 Otitis externa 153 0.56 0.78 0.12 -1.83
Theophylline 16 Theophylline 25 0.64 0.91 0.17 -1.64
Procyclidine hydrochloride 32 Antimuscarinic drugs used in parkinsonism 63 0.51 0.85 0.21 -1.64
Oral rehydration salts 13 Oral sodium and water 56 0.23 0.71 0.29 -1.62
Ibuprofen 94 Rubefacients, topical NSAIDS, capsaicin and poultice 475 0.20 0.52 0.20 -1.59
Apixaban 347 Oral anticoagulants 1,825 0.19 0.41 0.14 -1.55
Ranolazine 0 Other antianginal drugs 51 0.00 0.27 0.18 -1.50
    Doxycycline hyclate 154 Tetracyclines 302 0.51 0.70 0.12 -1.49