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Prototype Prescribing Outlier Dashboard for Manor Primary Care

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 Manor Primary Care is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chloramphenicol 1 Some other antibacterials 17 0.06 0.00 0.00 41.91
Metformin hydrochloride/sitagliptin 382 Other antidiabetic drugs 1,024 0.37 0.01 0.03 13.87
Hepatitis A 2 Vaccines and antisera 3 0.67 0.01 0.06 10.80
Celecoxib 93 Non-steroidal anti-inflammatory drugs 250 0.37 0.03 0.04 9.33
Eletriptan 31 Treatment of acute migraine 251 0.12 0.00 0.01 8.21
Sildenafil(Vasodilator Antihypertensive) 6 Vasodilator antihypertensive drugs 6 1.00 0.03 0.13 7.56
Testosterone 35 Male sex hormones and antagonists 81 0.43 0.07 0.06 5.99
Clindamycin/tretinoin 13 Topical preparations for acne 57 0.23 0.03 0.04 5.65
Canagliflozin/metformin 20 Other antidiabetic drugs 1,024 0.02 0.00 0.00 4.64
Tetracaine 10 Local anaesthetics 33 0.30 0.02 0.06 4.49

Prescribing where Manor Primary Care is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Naproxen 67 Non-steroidal anti-inflammatory drugs 250 0.27 0.69 0.10 -4.22
Finasteride 36 Male sex hormones and antagonists 81 0.44 0.82 0.11 -3.29
Influenza 0 Vaccines and antisera 3 0.00 0.88 0.28 -3.13
    Hydralazine hydrochloride 0 Vasodilator antihypertensive drugs 6 0.00 0.85 0.28 -3.04
      Hypromellose 2 Tear deficiency, eye lubricant/astringent 129 0.02 0.45 0.15 -2.85
      Macrogol 3350 155 Osmotic laxatives 352 0.44 0.71 0.10 -2.76
      Fusidic acid 13 Antibacterial preparations also used systemically 36 0.36 0.75 0.14 -2.73
      Coal tar 1 Shampoos and some other scalp preparations 39 0.03 0.40 0.15 -2.49
      Salbutamol 1,770 Selective beta(2)-agonists 2,221 0.80 0.91 0.04 -2.46
      Lidocaine hydrochloride 19 Local anaesthetics 33 0.58 0.90 0.13 -2.44