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Prototype Prescribing Outlier Dashboard for Carnon Downs 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 Carnon Downs Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Diamorphine hydrochloride (Systemic) 18 Opioid analgesics 974 0.02 0.00 0.00 9.83
Felodipine 3,251 Calcium-channel blockers 4,825 0.67 0.08 0.08 7.10
Indacaterol maleate 13 Selective beta(2)-agonists 1,119 0.01 0.00 0.00 7.04
Sirolimus 16 Corticosteroids and other immunosuppressants 16 1.00 0.03 0.14 7.00
Pilocarpine nitrate 23 Treatment of glaucoma 1,588 0.01 0.00 0.00 4.98
Loratadine 408 Antihistamines 944 0.43 0.12 0.06 4.95
Glycerol 41 Stimulant laxatives 234 0.18 0.04 0.03 4.83
Dexamethasone sodium metasulphobenzoate 27 Otitis externa 88 0.31 0.04 0.05 4.81
Dimeticone (Parasiticidal) 4 Parasiticidal preparations 7 0.57 0.04 0.12 4.55
Modafinil 13 CNS Stimulants and drugs used for ADHD 23 0.57 0.06 0.12 4.16

Prescribing where Carnon Downs Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amlodipine 1,129 Calcium-channel blockers 4,825 0.23 0.76 0.11 -4.64
Benzydamine hydrochloride 1 Drugs for oral ulceration and inflammation 3 0.33 0.84 0.16 -3.19
Midazolam hydrochloride 0 Drugs used in status epilepticus 3 0.00 0.80 0.28 -2.82
    Medroxyprogesterone acetate 6 Parenteral progestogen-only contraceptives 12 0.50 0.88 0.15 -2.49
    Ramipril 1,411 Angiotensin-converting enzyme inhibitors 4,924 0.29 0.69 0.17 -2.46
    Coal tar 1 Shampoos and some other scalp preparations 22 0.05 0.40 0.15 -2.36
    Methylphenidate hydrochloride 4 CNS Stimulants and drugs used for ADHD 23 0.17 0.65 0.20 -2.33
    Ferrous fumarate 21 Oral iron 382 0.05 0.57 0.23 -2.20
    Glycopyrronium bromide 1 Antimuscarinic drugs 16 0.06 0.82 0.35 -2.16
    Aspirin 1,920 Antiplatelet drugs 3,587 0.54 0.65 0.06 -1.90