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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Raltegravir 1 HIV infection 1 1.00 0.01 0.09 11.05
Spironolactone with loop diuretics 8 Potassium sparing diuretics and compounds 25 0.32 0.01 0.08 4.10
Aripiprazole 6 Antipsychotic depot injections 7 0.86 0.08 0.21 3.71
Paraffin soft yellow 25 Tear deficiency, eye lubricant/astringent 416 0.06 0.01 0.02 3.26
Gluten free/wheat free grains/flours 4 Foods for special diets 253 0.02 0.00 0.01 2.90
Malathion 3 Parasiticidal preparations 4 0.75 0.13 0.22 2.82
Ins degludec/liraglutide 15 Other antidiabetic drugs 1,038 0.01 0.00 0.00 2.63
Erythromycin stearate 6 Macrolides 300 0.02 0.00 0.01 2.45
Safinamide 18 Dopaminergic drugs used in parkinsonism 457 0.04 0.00 0.02 2.30
Aluminium and magnesium and activated simeticone 13 Antacids and simeticone 16 0.81 0.15 0.29 2.28

Prescribing where Castle Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Permethrin 1 Parasiticidal preparations 4 0.25 0.83 0.24 -2.42
Insulin aspart 143 Short-acting insulins 233 0.61 0.79 0.11 -1.57
Benzoyl peroxide and clindamycin phosphate 35 Topical preparations for acne 205 0.17 0.38 0.13 -1.52
Colecalciferol 1,416 Vitamin D 1,521 0.93 0.96 0.02 -1.33
Other emollient preparations 410 Emollients 512 0.80 0.89 0.07 -1.31
Hydroxychloroquine sulfate 49 Rheumatic disease suppressant drugs 287 0.17 0.37 0.16 -1.28
Norethisterone 9 Progestogens and progesterone receptor modulators 265 0.03 0.34 0.24 -1.28
Pizotifen malate 12 Prophylaxis of migraine 39 0.31 0.63 0.26 -1.25
Co-amilofruse (Amiloride hydrochloride/frusemide) 7 Potassium sparing diuretics and compounds 25 0.28 0.69 0.33 -1.25
Estriol 122 Preparations for vaginal/vulval changes 594 0.21 0.45 0.20 -1.22