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Prototype Prescribing Outlier Dashboard for Wansford

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 Wansford is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pyrimethamine 2 Antimalarials 285 0.01 0.00 0.00 11.16
Granisetron hydrochloride 4 Drugs used in nausea and vertigo 786 0.01 0.00 0.00 9.60
Hydrocortisone butyrate 42 Topical corticosteroids 1,147 0.04 0.00 0.01 6.60
Diamorphine hydrochloride (Systemic) 33 Opioid analgesics 2,725 0.01 0.00 0.00 6.33
Hyoscine 131 Drugs used in nausea and vertigo 786 0.17 0.02 0.02 6.29
Glycopyrronium bromide 117 Antispasmodic and other drugs altering gut motility 666 0.18 0.02 0.03 5.36
Sodium clodronate 13 Bisphosphonates and other drugs 663 0.02 0.00 0.00 3.91
Tetracycline 22 Tetracyclines 550 0.04 0.01 0.01 3.42
Low protein biscuits 8 Foods for special diets 142 0.06 0.00 0.02 3.38
Mycophenolic sodium 8 Antiproliferative immunosuppressants 91 0.09 0.01 0.03 3.19

Prescribing where Wansford is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Diazepam 362 Anxiolytics 926 0.39 0.75 0.13 -2.72
Other multivitamin preparations 21 Multivitamin preparations 53 0.40 0.82 0.21 -2.06
Moxonidine 0 Centrally-acting antihypertensive drugs 2 0.00 0.65 0.33 -1.95
    Amoxicillin 502 Broad-spectrum penicillins 692 0.73 0.85 0.07 -1.89
    Estradiol with progestogen 160 Oestrogens and Hormone Replacement Therapy 957 0.17 0.39 0.12 -1.88
    Neomycin sulfate 17 Nasal preparations for infection 29 0.59 0.84 0.14 -1.83
    Methylprednisolone acetate 3 Local corticosteroid injections 65 0.05 0.74 0.39 -1.77
    Glucose blood testing reagents 575 Diabetic diagnostic and monitoring agents 648 0.89 0.94 0.03 -1.62
    Midazolam hydrochloride 7 Drugs used in status epilepticus 19 0.37 0.80 0.28 -1.52
    Aripiprazole 46 Antipsychotic drugs 1,257 0.04 0.13 0.06 -1.49