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Prototype Prescribing Outlier Dashboard for Castlefields 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 Castlefields Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Bethanechol chloride 7 Drugs for urinary retention 905 0.01 0.00 0.00 13.90
Low protein grains/flours 16 Foods for special diets 490 0.03 0.00 0.00 6.74
Low protein breads 33 Foods for special diets 490 0.07 0.00 0.01 5.89
Liraglutide 521 Other antidiabetic drugs 2,848 0.18 0.03 0.03 5.85
Buspirone hydrochloride 586 Anxiolytics 1,578 0.37 0.03 0.06 5.32
Sodium citrate 1 Drugs used in urological pain 1 1.00 0.08 0.24 3.80
Dimeticone (Parasiticidal) 5 Parasiticidal preparations 11 0.45 0.04 0.12 3.56
Nitrazepam 280 Hypnotics 1,372 0.20 0.04 0.05 3.49
Low protein biscuits 26 Foods for special diets 490 0.05 0.00 0.02 3.16
Gluten free/low protein bread 34 Foods for special diets 490 0.07 0.01 0.02 3.04

Prescribing where Castlefields Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium citrate 0 Drugs used in urological pain 1 0.00 0.92 0.25 -3.67
    Diazepam 692 Anxiolytics 1,578 0.44 0.75 0.13 -2.37
    Donepezil hydrochloride 28 Drugs for dementia 390 0.07 0.49 0.18 -2.27
    Hydralazine hydrochloride 1 Vasodilator antihypertensive drugs 4 0.25 0.85 0.28 -2.15
    Carbimazole 104 Antithyroid drugs 145 0.72 0.93 0.10 -2.08
    Mesalazine (Systemic) 208 Aminosalicylates 572 0.36 0.65 0.15 -1.96
    Simvastatin 1,008 Lipid-regulating drugs 12,611 0.08 0.22 0.07 -1.83
    Other emollient preparations 474 Emollients 616 0.77 0.89 0.07 -1.77
    Salbutamol 4,647 Selective beta(2)-agonists 5,536 0.84 0.91 0.04 -1.51
    Glucose blood testing reagents 1,195 Diabetic diagnostic and monitoring agents 1,340 0.89 0.94 0.03 -1.49