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Prototype Prescribing Outlier Dashboard for Poole Town 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 Poole Town Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ketotifen fumarate 17 Other anti-inflammatory preparations 37 0.46 0.02 0.04 11.07
Lidocaine hydrochloride 10 Drugs for oral ulceration and inflammation 29 0.34 0.01 0.03 10.89
Heparin flushes 2 Parenteral anticoagulants 2 1.00 0.04 0.12 7.72
Triptorelin embonate 15 Prostate cancer and gonadorelin analogues 29 0.52 0.03 0.07 7.08
Vigabatrin 9 Control of epilepsy 863 0.01 0.00 0.00 6.66
Cyclizine lactate 31 Drugs used in nausea and vertigo 280 0.11 0.01 0.02 5.85
Indacaterol maleate 8 Selective beta(2)-agonists 919 0.01 0.00 0.00 5.20
Dronedarone hydrochloride 9 Drugs for arrhythmias 27 0.33 0.02 0.06 5.06
Clindamycin phosphate 6 Vaginal and vulval infections 29 0.21 0.03 0.04 4.75
Prednisolone sodium phosphate 11 Corticosteroids 21 0.52 0.07 0.10 4.59

Prescribing where Poole Town Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium citrate 1 Drugs used in urological pain 3 0.33 0.92 0.25 -2.34
Sodium cromoglicate 9 Other anti-inflammatory preparations 37 0.24 0.64 0.19 -2.11
Insulin aspart 87 Short-acting insulins 154 0.56 0.79 0.11 -2.00
Levonorgestrel 0 Emergency contraception 2 0.00 0.61 0.31 -1.97
    Atropine sulfate 0 Mydriatics and cycloplegics 1 0.00 0.72 0.37 -1.93
      Miconazole nitrate 2 Antifungal preparations 56 0.04 0.27 0.13 -1.81
      Bimatoprost 4 Treatment of glaucoma 506 0.01 0.11 0.06 -1.74
      Oral rehydration salts 1 Oral sodium and water 5 0.20 0.71 0.29 -1.74
      Oxybutynin 8 Drugs for urinary frequency enuresis and incontinence 322 0.02 0.18 0.09 -1.73
      Naproxen 250 Non-steroidal anti-inflammatory drugs 482 0.52 0.69 0.10 -1.72