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Prototype Prescribing Outlier Dashboard for Qhs Gp Care Home Service

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 Qhs Gp Care Home Service is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Citalopram hydrochloride 15 Selective serotonin re-uptake inhibitors 515 0.03 0.00 0.00 12.32
Choline salicylate 8 Drugs for oral ulceration and inflammation 11 0.73 0.03 0.07 9.94
Selenium sulfide 12 Shampoos and some other scalp preparations 29 0.41 0.03 0.04 8.66
Beclometdiprop/formoterol/glycopyrronium 39 Selective beta(2)-agonists 95 0.41 0.06 0.04 8.48
Modafinil 4 CNS Stimulants and drugs used for ADHD 4 1.00 0.06 0.12 7.76
Fluticasone propionate/azelastine hydrochloride (Nasal) 10 Drugs used in nasal allergy 19 0.53 0.06 0.06 7.52
Buprenorphine 473 Opioid analgesics 691 0.68 0.12 0.08 7.09
Febuxostat 8 Gout and cytotoxic induced hyperiuicaemia 37 0.22 0.02 0.03 7.06
Ciprofloxain/dexameth 1 Otitis externa 2 0.50 0.05 0.06 6.92
Lofepramine hydrochloride 7 Tricyclic and related antidepressant drugs 74 0.09 0.01 0.01 6.81

Prescribing where Qhs Gp Care Home Service is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Salbutamol 55 Selective beta(2)-agonists 95 0.58 0.91 0.04 -7.35
Amoxicillin 48 Broad-spectrum penicillins 119 0.40 0.85 0.07 -6.65
Aspirin 165 Antiplatelet drugs 459 0.36 0.65 0.06 -4.84
Quinine sulfate 14 Antimalarials 47 0.30 0.90 0.14 -4.40
Zopiclone 13 Hypnotics 244 0.05 0.60 0.14 -3.98
Benzydamine hydrochloride 3 Drugs for oral ulceration and inflammation 11 0.27 0.84 0.16 -3.57
Methylphenidate hydrochloride 0 CNS Stimulants and drugs used for ADHD 4 0.00 0.65 0.20 -3.18
    Mebeverine hydrochloride 3 Antispasmodic and other drugs altering gut motility 39 0.08 0.45 0.12 -3.01
    Prednisolone 50 Use of corticosteroids 70 0.71 0.89 0.06 -2.98
    Co-codamol (Codeine phosphate/paracetamol) 14 Non-opioid analgesics and compound preparations 1,580 0.01 0.45 0.15 -2.88