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Prototype Prescribing Outlier Dashboard for Hall Green Surgery

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 Hall Green Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tolvaptan 10 Posterior pituitary hormones and antagonists 37 0.27 0.00 0.01 30.95
Loperamide hydrochloride and simeticone 7 Antimotility drugs 114 0.06 0.00 0.01 8.27
Paracetamol combined preparations 13 Non-opioid analgesics and compound preparations 2,752 0.00 0.00 0.00 6.70
Diclofenac sodium 7 Ocular diagnostic & peri-operative prepn & photodynamic tt 9 0.78 0.03 0.12 6.03
Magnesium hydroxide 11 Antacids and simeticone 13 0.85 0.03 0.15 5.32
Clemastine fumarate 2 Antihistamines 947 0.00 0.00 0.00 5.21
Rutosides 7 Peripheral vasodilators and related drugs 7 1.00 0.06 0.19 4.97
Atenolol with calcium channel blocker 8 Beta-adrenoceptor blocking drugs 3,637 0.00 0.00 0.00 4.61
Phased formulations of ethinylestradiol 20 Combined hormonal contraceptives 251 0.08 0.01 0.02 4.50
Chlordiazepoxide hydrochloride 39 Anxiolytics 532 0.07 0.01 0.02 4.36

Prescribing where Hall Green Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Desmopressin acetate 27 Posterior pituitary hormones and antagonists 37 0.73 1.00 0.01 -30.95
Loperamide hydrochloride 107 Antimotility drugs 114 0.94 1.00 0.01 -5.54
Cetirizine hydrochloride 46 Antihistamines 947 0.05 0.28 0.11 -2.18
Cefalexin 53 Cephalosporins 70 0.76 0.96 0.10 -2.13
Oral rehydration salts 4 Oral sodium and water 38 0.11 0.71 0.29 -2.06
Lithium carbonate 8 Drugs used for mania and hypomania 84 0.10 0.61 0.28 -1.86
Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 7 0.00 0.67 0.39 -1.73
    Levetiracetam 84 Control of epilepsy 2,628 0.03 0.09 0.04 -1.60
    Fluconazole 10 Triazole antifungals 15 0.67 0.85 0.13 -1.39
    Ivermectin 4 Topical preparation for rosacea 7 0.57 0.88 0.22 -1.39