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Prototype Prescribing Outlier Dashboard for St Georges 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 St Georges Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ketoprofen 31 Non-steroidal anti-inflammatory drugs 1,284 0.02 0.00 0.00 7.20
Flurbiprofen sodium 1 Other anti-inflammatory preparations 117 0.01 0.00 0.00 6.69
Ceftazidime pentahydrate 1 Cephalosporins 169 0.01 0.00 0.00 5.56
Alverine citrate 181 Antispasmodic and other drugs altering gut motility 638 0.28 0.04 0.05 4.72
Dexamethasone phosphate 12 Use of corticosteroids 700 0.02 0.00 0.00 4.35
Mycophenolic sodium 11 Antiproliferative immunosuppressants 94 0.12 0.01 0.03 4.32
Felodipine 2,279 Calcium-channel blockers 5,711 0.40 0.08 0.08 3.83
Hyetellose 19 Tear deficiency, eye lubricant/astringent 356 0.05 0.01 0.01 3.18
Other eye tear/lubricant/astringent preparations 27 Tear deficiency, eye lubricant/astringent 356 0.08 0.01 0.02 3.17
Biphasic insulin aspart 256 Intermediate and long-acting insulins 596 0.43 0.14 0.09 3.16

Prescribing where St Georges Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amlodipine 2,964 Calcium-channel blockers 5,711 0.52 0.76 0.11 -2.10
Co-amilofruse (Amiloride hydrochloride/frusemide) 0 Potassium sparing diuretics and compounds 14 0.00 0.69 0.33 -2.10
    Fusidic acid 34 Antibacterial preparations also used systemically 74 0.46 0.75 0.14 -2.03
    Latanoprost 169 Treatment of glaucoma 1,177 0.14 0.31 0.08 -2.00
    Hydroxychloroquine sulfate 23 Rheumatic disease suppressant drugs 394 0.06 0.37 0.16 -1.99
    Senna 508 Stimulant laxatives 1,777 0.29 0.55 0.14 -1.92
    Famotidine 31 H2-Receptor antagonists 75 0.41 0.81 0.21 -1.90
    Water for injection 24 Electrolytes and water 64 0.38 0.82 0.25 -1.81
    Other multivitamin preparations 337 Multivitamin preparations 735 0.46 0.82 0.21 -1.76
    Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 4 0.00 0.67 0.39 -1.73