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Prototype Prescribing Outlier Dashboard for Prescott 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 Prescott Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Perindopril arginine 427 Angiotensin-converting enzyme inhibitors 4,058 0.11 0.00 0.00 54.36
Diclofenac sodium 202 Rubefacients, topical NSAIDS, capsaicin and poultice 425 0.48 0.00 0.01 47.83
Perindopril arginine with diuretic 92 Angiotensin-converting enzyme inhibitors 4,058 0.02 0.00 0.00 9.71
Telmisartan 350 Angiotensin-II receptor antagonists 1,962 0.18 0.01 0.02 7.41
Quinine bisulfate 153 Antimalarials 204 0.75 0.10 0.13 4.82
Aripiprazole 6 Antipsychotic depot injections 6 1.00 0.08 0.21 4.39
Pantoprazole 680 Proton pump inhibitors 5,860 0.12 0.02 0.02 4.31
Loteprednol etabonate 12 Corticosteroids 53 0.23 0.02 0.05 3.91
Dutasteride 150 Male sex hormones and antagonists 483 0.31 0.06 0.07 3.53
Ketone blood testing reagents 52 Diabetic diagnostic and monitoring agents 350 0.15 0.05 0.03 3.39

Prescribing where Prescott Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Quinine sulfate 51 Antimalarials 204 0.25 0.90 0.14 -4.75
Mirtazapine 308 Other antidepressant drugs 1,091 0.28 0.57 0.10 -2.72
Glucose blood testing reagents 298 Diabetic diagnostic and monitoring agents 350 0.85 0.94 0.03 -2.68
Finasteride 256 Male sex hormones and antagonists 483 0.53 0.82 0.11 -2.54
Betamethasone valerate 90 Topical corticosteroids 564 0.16 0.28 0.07 -1.84
Ferrous fumarate 79 Oral iron 560 0.14 0.57 0.23 -1.83
Amiodarone hydrochloride 1 Drugs for arrhythmias 49 0.02 0.48 0.25 -1.81
Oral rehydration salts 4 Oral sodium and water 21 0.19 0.71 0.29 -1.77
Cabergoline 5 Bromocriptine and other dopaminergic drugs 13 0.38 0.86 0.27 -1.75
Methylprednisolone acetate 1 Local corticosteroid injections 16 0.06 0.74 0.39 -1.73