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Prototype Prescribing Outlier Dashboard for Queens Park 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 Queens Park Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dienogest 8 Progestogens and progesterone receptor modulators 102 0.08 0.00 0.01 7.17
Apomorphine hydrochloride hemihydrate 8 Dopaminergic drugs used in parkinsonism 720 0.01 0.00 0.00 6.66
Lormetazepam 21 Hypnotics 748 0.03 0.00 0.01 5.05
Mometasone/glycopyrronium/indacaterol 6 Corticosteroids (respiratory) 5,483 0.00 0.00 0.00 3.98
Clomethiazole 17 Hypnotics 748 0.02 0.00 0.01 3.77
Nitrazepam 158 Hypnotics 748 0.21 0.04 0.05 3.65
Lacidipine 1,089 Calcium-channel blockers 11,162 0.10 0.01 0.03 3.13
Hydrocortisone sodium succinate 11 Use of corticosteroids 1,210 0.01 0.00 0.00 3.03
Meloxicam 399 Non-steroidal anti-inflammatory drugs 2,661 0.15 0.03 0.04 2.68
Tinzaparin sodium 70 Parenteral anticoagulants 73 0.96 0.16 0.30 2.64

Prescribing where Queens Park Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Folic acid 760 Drugs used in megaloblastic anaemias 3,337 0.23 0.69 0.16 -2.96
Quinine sulfate 206 Antimalarials 370 0.56 0.90 0.14 -2.50
Zopiclone 224 Hypnotics 748 0.30 0.60 0.14 -2.20
Senna 610 Stimulant laxatives 2,300 0.27 0.55 0.14 -2.07
Other multivitamin preparations 61 Multivitamin preparations 153 0.40 0.82 0.21 -2.05
Co-codamol (Codeine phosphate/paracetamol) 1,215 Non-opioid analgesics and compound preparations 6,389 0.19 0.45 0.15 -1.70
Omeprazole 4,088 Proton pump inhibitors 18,005 0.23 0.50 0.16 -1.67
Clarithromycin 256 Macrolides 770 0.33 0.57 0.16 -1.51
Medroxyprogesterone acetate 0 Progestogens 4 0.00 0.66 0.45 -1.46
    Tacrolimus 20 Drugs affecting the immune response 38 0.53 0.81 0.19 -1.44