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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Budesonide 166 Drugs used in nasal allergy 809 0.21 0.01 0.02 10.79
Dimeticone (Parasiticidal) 1 Parasiticidal preparations 1 1.00 0.04 0.12 8.19
Phenytoin 15 Control of epilepsy 1,367 0.01 0.00 0.00 7.17
Chloral hydrate 10 Hypnotics 269 0.04 0.00 0.01 5.34
Triptorelin 21 Prostate cancer and gonadorelin analogues 27 0.78 0.09 0.16 4.45
Mepyramine maleate 2 Topical local anaesthetics and antipruritics 18 0.11 0.00 0.03 3.94
Co-beneldopa (Benserazide/levodopa) 269 Dopaminergic drugs used in parkinsonism 346 0.78 0.22 0.15 3.79
Fluocinonide 7 Topical corticosteroids 656 0.01 0.00 0.00 3.75
Podophyllotoxin 2 Preparations for warts and calluses 4 0.50 0.05 0.12 3.59
Pentosan polysulfate sodium 2 Oral anticoagulants 1,386 0.00 0.00 0.00 3.54

Prescribing where St. Mary'S Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Permethrin 0 Parasiticidal preparations 1 0.00 0.83 0.24 -3.46
    Midazolam hydrochloride 0 Drugs used in status epilepticus 12 0.00 0.80 0.28 -2.82
      Glycopyrronium bromide 0 Antimuscarinic drugs 2 0.00 0.82 0.35 -2.34
        Co-amilofruse (Amiloride hydrochloride/frusemide) 0 Potassium sparing diuretics and compounds 6 0.00 0.69 0.33 -2.10
          Ramipril 1,419 Angiotensin-converting enzyme inhibitors 3,957 0.36 0.69 0.17 -2.02
          Clobetasol propionate 16 Topical corticosteroids 656 0.02 0.08 0.03 -1.86
          Mometasone furoate 64 Drugs used in nasal allergy 809 0.08 0.32 0.13 -1.82
          Amoxicillin 217 Broad-spectrum penicillins 291 0.75 0.85 0.07 -1.59
          Diclofenac diethyl 6 Rubefacients, topical NSAIDS, capsaicin and poultice 358 0.02 0.29 0.18 -1.57
          Miconazole nitrate 7 Antifungal preparations 103 0.07 0.27 0.13 -1.56