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Prototype Prescribing Outlier Dashboard for Woodside 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 Woodside Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Castor oil 1 Stimulant laxatives 619 0.00 0.00 0.00 48.82
Hydroxyzine hydrochloride 704 Antihistamines 2,290 0.31 0.03 0.03 10.62
Tazarotene 1 Preparations for psoriasis 164 0.01 0.00 0.00 7.98
Methocarbamol 281 Skeletal muscle relaxants 325 0.86 0.08 0.15 5.19
Carbomer 974P 29 Tear deficiency, eye lubricant/astringent 292 0.10 0.01 0.02 4.73
Flavoxate hydrochloride 19 Drugs for urinary frequency enuresis and incontinence 692 0.03 0.00 0.01 4.68
Paroxetine hydrochloride 415 Selective serotonin re-uptake inhibitors 3,858 0.11 0.03 0.02 4.36
Ramipril with calcium channel blocker 8 Angiotensin-converting enzyme inhibitors 2,781 0.00 0.00 0.00 4.31
Bromfenac 3 Ocular diagnostic & peri-operative prepn & photodynamic tt 3 1.00 0.09 0.21 4.25
Buspirone hydrochloride 115 Anxiolytics 380 0.30 0.03 0.06 4.23

Prescribing where Woodside Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Baclofen 44 Skeletal muscle relaxants 325 0.14 0.83 0.18 -3.82
Glucose blood testing reagents 533 Diabetic diagnostic and monitoring agents 622 0.86 0.94 0.03 -2.52
Vitamin A 0 Vitamin A 5 0.00 0.82 0.36 -2.28
    Codeine phosphate 0 Cough suppressants 1 0.00 0.74 0.33 -2.22
      Warfarin sodium 5 Oral anticoagulants 961 0.01 0.24 0.11 -2.14
      Estradiol 18 Preparations for vaginal/vulval changes 150 0.12 0.55 0.20 -2.07
      Rifampicin 0 Antituberculosis drugs 3 0.00 0.74 0.40 -1.88
        Mupirocin 0 Antibacterial preparations only used topically 4 0.00 0.64 0.36 -1.79
          Famotidine 7 H2-Receptor antagonists 16 0.44 0.81 0.21 -1.78
          Macrogol 3350 501 Osmotic laxatives 920 0.54 0.71 0.10 -1.68