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Prototype Prescribing Outlier Dashboard for Clapham Junction Medical 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 Clapham Junction Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Eslicarbazepine acetate 32 Control of epilepsy 744 0.04 0.00 0.00 15.22
Co-tenidone (Atenolol/chlortalidone) 55 Beta-adrenoceptor blocking drugs 827 0.07 0.00 0.00 12.93
Lacosamide 62 Control of epilepsy 744 0.08 0.01 0.01 8.36
Solifenacin/tamsulosin 40 Drugs for urinary retention 317 0.13 0.01 0.01 8.22
Beclometasone dipropionate (Systemic) 2 Corticosteroids 2 1.00 0.04 0.13 7.59
Heparinoid 100 Rubefacients, topical NSAIDS, capsaicin and poultice 370 0.27 0.03 0.04 5.77
Losartan potassium with diuretic 60 Angiotensin-II receptor antagonists 729 0.08 0.01 0.02 4.63
Proguanil hydrochloride with atovaquone 1 Antimalarials 87 0.01 0.00 0.00 4.48
Sitagliptin 560 Other antidiabetic drugs 733 0.76 0.17 0.14 4.32
Diclofenac sodium 31 Non-steroidal anti-inflammatory drugs 173 0.18 0.04 0.03 4.27

Prescribing where Clapham Junction Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Naproxen 69 Non-steroidal anti-inflammatory drugs 173 0.40 0.69 0.10 -2.91
Macrogol 3350 83 Osmotic laxatives 192 0.43 0.71 0.10 -2.85
Spironolactone 42 Potassium-sparing diuretics and aldosterone antagonists 114 0.37 0.72 0.14 -2.55
Prochlorperazine maleate 3 Drugs used in nausea and vertigo 68 0.04 0.25 0.08 -2.44
Fluoxetine hydrochloride 20 Selective serotonin re-uptake inhibitors 529 0.04 0.16 0.05 -2.37
Morphine sulfate 3 Opioid analgesics 130 0.02 0.20 0.08 -2.32
Budesonide 0 Corticosteroids 2 0.00 0.71 0.32 -2.21
    Memantine hydrochloride 0 Drugs for dementia 62 0.00 0.38 0.18 -2.13
      Fexofenadine hydrochloride 47 Antihistamines 457 0.10 0.34 0.12 -2.04
      Gabapentin 59 Control of epilepsy 744 0.08 0.24 0.08 -1.96