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Prototype Prescribing Outlier Dashboard for The Discovery Practice

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 The Discovery Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Disopyramide phosphate 4 Drugs for arrhythmias 4 1.00 0.00 0.02 47.90
Methyl salicylate/levomenthol 3 Rubefacients, topical NSAIDS, capsaicin and poultice 422 0.01 0.00 0.00 18.28
Hydrogen peroxide 3 Mouth-washes, gargles and dentifrices 8 0.38 0.01 0.06 6.57
Cyproterone acetate 1 Male sex hormones and antagonists 194 0.01 0.00 0.00 4.82
Trazodone hydrochloride 634 Tricyclic and related antidepressant drugs 1,868 0.34 0.06 0.06 4.76
Piroxicam 195 Rubefacients, topical NSAIDS, capsaicin and poultice 422 0.46 0.05 0.09 4.63
Tibolone 32 Oestrogens and Hormone Replacement Therapy 132 0.24 0.05 0.05 3.69
Dexamethasone 46 Use of corticosteroids 423 0.11 0.03 0.02 3.57
Phosphates (Rectal) 20 Osmotic laxatives 533 0.04 0.01 0.01 3.40
Methocarbamol 105 Skeletal muscle relaxants 182 0.58 0.08 0.15 3.28

Prescribing where The Discovery Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine gluconate 5 Mouth-washes, gargles and dentifrices 8 0.62 0.97 0.11 -3.28
Amitriptyline hydrochloride 1,110 Tricyclic and related antidepressant drugs 1,868 0.59 0.84 0.08 -3.26
Baclofen 77 Skeletal muscle relaxants 182 0.42 0.83 0.18 -2.23
Bisoprolol fumarate 1,192 Beta-adrenoceptor blocking drugs 2,420 0.49 0.65 0.08 -2.03
Progesterone 0 Progestogens and progesterone receptor modulators 26 0.00 0.53 0.27 -1.96
    Lithium carbonate 4 Drugs used for mania and hypomania 53 0.08 0.61 0.28 -1.93
    Amiodarone hydrochloride 0 Drugs for arrhythmias 4 0.00 0.48 0.25 -1.89
      Flecainide acetate 0 Drugs for arrhythmias 4 0.00 0.46 0.25 -1.84
        Estradiol 30 Oestrogens and Hormone Replacement Therapy 132 0.23 0.47 0.14 -1.74
        Aspirin 896 Antiplatelet drugs 1,640 0.55 0.65 0.06 -1.71