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Prototype Prescribing Outlier Dashboard for West Barnes 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 West Barnes Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Diphenhydramine hydrochloride 361 Antihistamines 1,351 0.27 0.00 0.01 40.11
Loperamide hydrochloride and simeticone 4 Antimotility drugs 24 0.17 0.00 0.01 22.78
Co-proxamol (Dextropropoxyphene hydrochloride/paracetamol) 24 Non-opioid analgesics and compound preparations 1,430 0.02 0.00 0.00 16.82
Iron and folic acid 38 Oral iron 619 0.06 0.00 0.01 9.73
Indometacin 55 Non-steroidal anti-inflammatory drugs 637 0.09 0.01 0.01 6.40
Dicycloverine hydrochloride 8 Antispasmodic and other drugs altering gut motility 91 0.09 0.01 0.01 6.29
Arachis oil 1 Shampoos and some other scalp preparations 105 0.01 0.00 0.00 5.61
Metformin hydrochloride/sitagliptin 201 Other antidiabetic drugs 1,387 0.14 0.01 0.03 5.16
Estradiol and nomegestrol 2 Combined hormonal contraceptives 140 0.01 0.00 0.00 4.37
Amiloride hydrochloride 72 Potassium-sparing diuretics and aldosterone antagonists 355 0.20 0.03 0.04 4.27

Prescribing where West Barnes Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Loperamide hydrochloride 20 Antimotility drugs 24 0.83 1.00 0.01 -15.41
Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
    Neomycin sulfate 8 Nasal preparations for infection 17 0.47 0.84 0.14 -2.68
    Losartan potassium 126 Angiotensin-II receptor antagonists 1,432 0.09 0.50 0.19 -2.23
    Hypromellose 52 Tear deficiency, eye lubricant/astringent 319 0.16 0.45 0.15 -1.89
    Cyclizine hydrochloride 12 Drugs used in nausea and vertigo 328 0.04 0.17 0.07 -1.81
    Mupirocin 0 Antibacterial preparations only used topically 1 0.00 0.64 0.36 -1.79
      Naproxen 326 Non-steroidal anti-inflammatory drugs 637 0.51 0.69 0.10 -1.78
      Cetirizine hydrochloride 126 Antihistamines 1,351 0.09 0.28 0.11 -1.76
      Tacrolimus 0 Corticosteroids and other immunosuppressants 36 0.00 0.63 0.40 -1.58