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Prototype Prescribing Outlier Dashboard for Brannam Medical 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 Brannam Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ergotamine tartrate 1 Treatment of acute migraine 783 0.00 0.00 0.00 49.38
Sulfur 2 Topical preparations for acne 270 0.01 0.00 0.00 15.90
Glipizide 89 Sulfonylureas 1,454 0.06 0.00 0.01 6.25
Nebivolol 585 Beta-adrenoceptor blocking drugs 6,655 0.09 0.02 0.02 4.18
Magnesium oxide 7 Antacids and simeticone 9 0.78 0.05 0.18 4.01
Metolazone 39 Thiazides and related diuretics 2,218 0.02 0.00 0.00 3.51
Docusate sodium 1,074 Stimulant laxatives 1,641 0.65 0.25 0.14 2.98
Isophane insulin 426 Intermediate and long-acting insulins 1,013 0.42 0.12 0.10 2.93
Glycopyrronium bromide 2 Antiperspirants 15 0.13 0.00 0.05 2.86
Diltiazem hydrochloride 777 Calcium-channel blockers 6,675 0.12 0.05 0.03 2.52

Prescribing where Brannam Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aluminium chloride 13 Antiperspirants 15 0.87 0.99 0.05 -2.69
Senna 325 Stimulant laxatives 1,641 0.20 0.55 0.14 -2.55
Lactulose 166 Osmotic laxatives 1,717 0.10 0.28 0.10 -1.90
Hydralazine hydrochloride 8 Vasodilator antihypertensive drugs 25 0.32 0.85 0.28 -1.90
Glycopyrronium bromide 7 Antimuscarinic drugs 43 0.16 0.82 0.35 -1.88
Aspirin 3,599 Antiplatelet drugs 6,681 0.54 0.65 0.06 -1.84
Tacrolimus 0 Corticosteroids and other immunosuppressants 2 0.00 0.63 0.40 -1.58
    Miconazole nitrate 23 Antifungal preparations 343 0.07 0.27 0.13 -1.57
    Losartan potassium 827 Angiotensin-II receptor antagonists 3,603 0.23 0.50 0.19 -1.46
    Umeclidinium bromide/vilanterol 35 Compound bronchodilator preparations 483 0.07 0.50 0.30 -1.44