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Prototype Prescribing Outlier Dashboard for St Paul'S 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 St Paul'S Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-phenotrope (Diphenox hydrochloride/atropine sulfate) 9 Antimotility drugs 203 0.04 0.00 0.00 9.58
Doxylamine succinate/pyridoxine hydrochloride 27 Drugs used in nausea and vertigo 590 0.05 0.00 0.01 8.94
Magnesium hydroxide 1 Antacids and simeticone 1 1.00 0.03 0.15 6.33
Rufinamide 25 Control of epilepsy 2,944 0.01 0.00 0.00 5.27
Low protein cooking aids 3 Foods for special diets 201 0.01 0.00 0.00 4.37
Denosumab 65 Bisphosphonates and other drugs 737 0.09 0.01 0.02 4.24
Ins degludec/liraglutide 17 Other antidiabetic drugs 856 0.02 0.00 0.00 3.72
Other eye tear/lubricant/astringent preparations 23 Tear deficiency, eye lubricant/astringent 269 0.09 0.01 0.02 3.64
Liothyronine sodium 30 Thyroid hormones 2,859 0.01 0.00 0.00 3.22
Ciclesonide 33 Corticosteroids (respiratory) 2,228 0.01 0.00 0.00 3.17

Prescribing where St Paul'S Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Loperamide hydrochloride 194 Antimotility drugs 203 0.96 1.00 0.01 -3.94
Levothyroxine sodium 2,829 Thyroid hormones 2,859 0.99 1.00 0.00 -3.13
Finasteride 185 Male sex hormones and antagonists 302 0.61 0.82 0.11 -1.81
Vitamin E 0 Vitamin E 2 0.00 0.72 0.41 -1.76
    Glucose blood testing reagents 552 Diabetic diagnostic and monitoring agents 622 0.89 0.94 0.03 -1.62
    Aciclovir 152 Herpes simplex and varicella-zoster 179 0.85 0.95 0.07 -1.58
    Calcium carbonate 9 Calcium supplements 12 0.75 0.95 0.13 -1.53
    Fluconazole 66 Triazole antifungals 101 0.65 0.85 0.13 -1.49
    Docusate sodium 28 Stimulant laxatives 545 0.05 0.25 0.14 -1.44
    Salicylic acid 3 Preparations for warts and calluses 12 0.25 0.67 0.31 -1.36