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Prototype Prescribing Outlier Dashboard for The Spires Health 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 The Spires Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Bifonazole 1 Antifungal preparations 63 0.02 0.00 0.00 16.15
Nystatin 7 Antifungal preparations 63 0.11 0.00 0.01 13.89
Capsaicin 204 Rubefacients, topical NSAIDS, capsaicin and poultice 428 0.48 0.05 0.05 8.39
Liquid paraffin 43 Tear deficiency, eye lubricant/astringent 463 0.09 0.01 0.01 6.48
Calcium polystyrene sulfonate 5 Oral potassium 12 0.42 0.01 0.07 5.69
Doxylamine succinate/pyridoxine hydrochloride 17 Drugs used in nausea and vertigo 587 0.03 0.00 0.01 5.58
Tolfenamic acid 9 Treatment of acute migraine 213 0.04 0.00 0.01 5.55
Betamethasone esters 115 Topical corticosteroids 771 0.15 0.03 0.02 4.87
Duloxetine hydrochloride 656 Other antidepressant drugs 1,400 0.47 0.15 0.07 4.23
Ciprofloxacin 30 Antibacterials 97 0.31 0.05 0.06 4.19

Prescribing where The Spires Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium chloride 6 Oral potassium 12 0.50 0.96 0.14 -3.33
Mirtazapine 348 Other antidepressant drugs 1,400 0.25 0.57 0.10 -3.05
Quinine sulfate 47 Antimalarials 91 0.52 0.90 0.14 -2.79
Tamsulosin hydrochloride 284 Drugs for urinary retention 376 0.76 0.92 0.06 -2.76
Codeine phosphate 0 Cough suppressants 4 0.00 0.74 0.33 -2.22
    Alfentanil hydrochloride 0 Opioid analgesics 3 0.00 0.82 0.38 -2.18
      Memantine hydrochloride 0 Drugs for dementia 48 0.00 0.38 0.18 -2.13
        Levonorgestrel 0 Emergency contraception 4 0.00 0.61 0.31 -1.97
          Flecainide acetate 0 Drugs for arrhythmias 26 0.00 0.46 0.25 -1.84
            Clarithromycin 62 Macrolides 219 0.28 0.57 0.16 -1.82