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Prototype Prescribing Outlier Dashboard for Montpelier 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 Montpelier Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Exemestane 63 Breast cancer 133 0.47 0.06 0.07 6.09
Magnesium oxide 17 Antacids and simeticone 18 0.94 0.05 0.18 4.92
Isometheptene mucate 2 Non-opioid analgesics and compound preparations 2,840 0.00 0.00 0.00 3.77
Budesonide 43 Drugs used in nasal allergy 565 0.08 0.01 0.02 3.64
Ketone blood testing reagents 117 Diabetic diagnostic and monitoring agents 771 0.15 0.05 0.03 3.49
Galantamine 63 Drugs for dementia 298 0.21 0.03 0.06 3.06
Lacosamide 148 Control of epilepsy 4,306 0.03 0.01 0.01 2.99
Solifenacin/tamsulosin 35 Drugs for urinary retention 722 0.05 0.01 0.01 2.92
Brivaracetam 53 Control of epilepsy 4,306 0.01 0.00 0.00 2.77
Prazosin hydrochloride 25 Alpha-adrenoceptor blocking drugs 686 0.04 0.00 0.01 2.67

Prescribing where Montpelier Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glucose blood testing reagents 654 Diabetic diagnostic and monitoring agents 771 0.85 0.94 0.03 -2.78
Water for injection 1 Electrolytes and water 4 0.25 0.82 0.25 -2.32
Medroxyprogesterone acetate 65 Parenteral progestogen-only contraceptives 118 0.55 0.88 0.15 -2.16
Salicylic acid 1 Preparations for warts and calluses 8 0.12 0.67 0.31 -1.76
Timolol and bimatoprost 11 Treatment of glaucoma 669 0.02 0.10 0.05 -1.62
Gabapentin 461 Control of epilepsy 4,306 0.11 0.24 0.08 -1.61
Alendronic acid 242 Bisphosphonates and other drugs 334 0.72 0.87 0.09 -1.60
Atenolol 166 Beta-adrenoceptor blocking drugs 3,454 0.05 0.13 0.05 -1.59
Hydrocortisone 23 Copound haemorrhoidal preparations with corticosteroid 118 0.19 0.57 0.24 -1.54
Famotidine 18 H2-Receptor antagonists 36 0.50 0.81 0.21 -1.49