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Prototype Prescribing Outlier Dashboard for The Roseberry 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 Roseberry Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Doxycycline hyclate 3 Drugs for oral ulceration and inflammation 13 0.23 0.00 0.02 14.00
Formaldehyde 1 Preparations for warts and calluses 9 0.11 0.00 0.01 9.76
Medroxyprogesterone acetate 24 Progestogens and progesterone receptor modulators 31 0.77 0.13 0.13 4.75
Antazoline 9 Other anti-inflammatory preparations 65 0.14 0.01 0.03 4.57
Levofloxacin 4 Antibacterials 62 0.06 0.01 0.02 3.54
Indacaterol/glycopyrronium 58 Compound bronchodilator preparations 77 0.75 0.15 0.20 3.04
Exenatide 29 Other antidiabetic drugs 946 0.03 0.00 0.01 2.96
Salmeterol 91 Selective beta(2)-agonists 2,258 0.04 0.01 0.01 2.95
Gluten free/low protein grains/flours 6 Foods for special diets 332 0.02 0.00 0.01 2.89
Paraffin soft yellow 16 Tear deficiency, eye lubricant/astringent 297 0.05 0.01 0.02 2.88

Prescribing where The Roseberry Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Folic acid 249 Drugs used in megaloblastic anaemias 946 0.26 0.69 0.16 -2.73
Zopiclone 52 Hypnotics 216 0.24 0.60 0.14 -2.62
Senna 188 Stimulant laxatives 909 0.21 0.55 0.14 -2.49
Benzydamine hydrochloride 6 Drugs for oral ulceration and inflammation 13 0.46 0.84 0.16 -2.39
Estradiol 45 Oestrogens and Hormone Replacement Therapy 198 0.23 0.47 0.14 -1.74
Calcium carbonate 16 Calcium supplements 22 0.73 0.95 0.13 -1.70
Clarithromycin 68 Macrolides 219 0.31 0.57 0.16 -1.65
Moxonidine 8 Centrally-acting antihypertensive drugs 78 0.10 0.65 0.33 -1.65
Tamsulosin hydrochloride 741 Drugs for urinary retention 900 0.82 0.92 0.06 -1.61
Sodium picosulfate 0 Bowel cleansing preparations 1 0.00 0.69 0.43 -1.61