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Prototype Prescribing Outlier Dashboard for Dr Manickam & Partner

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 Dr Manickam & Partner is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ibuprofen lysine 3 Non-steroidal anti-inflammatory drugs 181 0.02 0.00 0.00 14.82
Phased formulations of ethinylestradiol 26 Combined hormonal contraceptives 200 0.13 0.01 0.02 7.73
Selenium sulfide 6 Shampoos and some other scalp preparations 23 0.26 0.03 0.04 5.17
Insulin glulisine 48 Short-acting insulins 166 0.29 0.03 0.05 4.83
Citalopram hydrochloride 22 Selective serotonin re-uptake inhibitors 1,874 0.01 0.00 0.00 4.60
Diflucortolone valerate 2 Topical corticosteroids 407 0.00 0.00 0.00 3.96
Tars 7 Preparations for psoriasis 38 0.18 0.04 0.04 3.55
Sacubitril/valsartan 61 Angiotensin-II receptor antagonists 587 0.10 0.03 0.02 3.55
Almotriptan 13 Treatment of acute migraine 141 0.09 0.01 0.02 3.53
Brinzolamide and timolol 28 Treatment of glaucoma 356 0.08 0.02 0.02 2.99

Prescribing where Dr Manickam & Partner is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glucose blood testing reagents 270 Diabetic diagnostic and monitoring agents 313 0.86 0.94 0.03 -2.35
Prucalopride 0 Other drugs used in constipation 4 0.00 0.71 0.32 -2.19
    Progesterone 0 Progestogens and progesterone receptor modulators 11 0.00 0.53 0.27 -1.96
      Clotrimazole 4 Antifungal preparations 32 0.12 0.43 0.16 -1.88
      Prednisolone 0 Copound haemorrhoidal preparations with corticosteroid 41 0.00 0.43 0.24 -1.80
        Mupirocin 0 Antibacterial preparations only used topically 1 0.00 0.64 0.36 -1.79
          Duloxetine hydrochloride 11 Other antidepressant drugs 494 0.02 0.15 0.07 -1.79
          Insulin aspart 98 Short-acting insulins 166 0.59 0.79 0.11 -1.77
          Indapamide 70 Thiazides and related diuretics 448 0.16 0.43 0.16 -1.71
          Timolol 2 Treatment of glaucoma 356 0.01 0.06 0.03 -1.62