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Prototype Prescribing Outlier Dashboard for Westcroft Health Centre

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 Westcroft Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Formaldehyde 1 Preparations for warts and calluses 3 0.33 0.00 0.01 29.42
Methyl salicylate/levomenthol 1 Rubefacients, topical NSAIDS, capsaicin and poultice 139 0.01 0.00 0.00 18.50
Phenytoin 31 Control of epilepsy 2,559 0.01 0.00 0.00 7.95
Sodium chloride 8 Tear deficiency, eye lubricant/astringent 81 0.10 0.00 0.01 7.83
Benzylpenicillin sodium (Penicillin G) 1 Benzylpenicillin and phenoxymethylpenicillin 159 0.01 0.00 0.00 6.81
Ciprofloxain/dexameth 61 Otitis externa 193 0.32 0.05 0.06 4.07
Aclidinium bromide/formoterol 69 Compound bronchodilator preparations 95 0.73 0.12 0.17 3.60
Isosorbide dinitrate 39 Nitrates 377 0.10 0.01 0.03 3.58
Morphine sulfate 474 Opioid analgesics 1,061 0.45 0.20 0.08 3.11
Magnesium citrate 2 Bowel cleansing preparations 4 0.50 0.03 0.16 2.98

Prescribing where Westcroft Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenoxymethylpenicillin (Penicillin V) 158 Benzylpenicillin and phenoxymethylpenicillin 159 0.99 1.00 0.00 -6.81
Trimethoprim 44 Sulfonamides and trimethoprim 85 0.52 0.87 0.12 -2.89
Codeine phosphate 0 Cough suppressants 1 0.00 0.74 0.33 -2.22
    Glucose blood testing reagents 599 Diabetic diagnostic and monitoring agents 690 0.87 0.94 0.03 -2.19
    Salicylic acid 0 Preparations for warts and calluses 3 0.00 0.67 0.31 -2.17
      Co-amilofruse (Amiloride hydrochloride/frusemide) 0 Potassium sparing diuretics and compounds 3 0.00 0.69 0.33 -2.10
        Neomycin sulfate 15 Nasal preparations for infection 27 0.56 0.84 0.14 -2.05
        Allopurinol 222 Gout and cytotoxic induced hyperiuicaemia 279 0.80 0.90 0.05 -1.96
        Mometasone furoate 37 Drugs used in nasal allergy 546 0.07 0.32 0.13 -1.91
        Lithium carbonate 8 Drugs used for mania and hypomania 82 0.10 0.61 0.28 -1.85