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Prototype Prescribing Outlier Dashboard for Riverside Medical 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 Riverside Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Penicillamine 23 Rheumatic disease suppressant drugs 95 0.24 0.00 0.01 26.90
Apomorphine hydrochloride hemihydrate 5 Dopaminergic drugs used in parkinsonism 236 0.02 0.00 0.00 12.78
Terazosin hydrochloride 34 Alpha-adrenoceptor blocking drugs 213 0.16 0.01 0.01 11.28
Darifenacin hydrobromide 170 Drugs for urinary frequency enuresis and incontinence 484 0.35 0.01 0.03 9.77
Lidocaine hydrochloride 3 Drugs for oral ulceration and inflammation 11 0.27 0.01 0.03 8.55
Nicotine bitartrate 7 Nicotine dependence 30 0.23 0.00 0.03 8.16
Dimenhydrinate/cinnarizine 16 Drugs used in nausea and vertigo 521 0.03 0.00 0.00 7.97
Celiprolol hydrochloride 36 Beta-adrenoceptor blocking drugs 3,039 0.01 0.00 0.00 7.62
Glycopyrronium bromide 404 Antimuscarinic bronchodilators 681 0.59 0.06 0.10 5.39
Meloxicam 272 Non-steroidal anti-inflammatory drugs 1,073 0.25 0.03 0.04 5.04

Prescribing where Riverside Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Doxazosin mesilate 179 Alpha-adrenoceptor blocking drugs 213 0.84 0.99 0.02 -7.79
Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
    Tiotropium bromide 182 Antimuscarinic bronchodilators 681 0.27 0.71 0.18 -2.47
    Mirabegron 7 Drugs for urinary frequency enuresis and incontinence 484 0.01 0.23 0.09 -2.34
    Hydroxychloroquine sulfate 1 Rheumatic disease suppressant drugs 95 0.01 0.37 0.16 -2.30
    Budesonide 0 Corticosteroids 1 0.00 0.71 0.32 -2.21
      Folic acid 274 Drugs used in megaloblastic anaemias 777 0.35 0.69 0.16 -2.16
      Other multivitamin preparations 45 Multivitamin preparations 113 0.40 0.82 0.21 -2.05
      Amitriptyline hydrochloride 865 Tricyclic and related antidepressant drugs 1,257 0.69 0.84 0.08 -2.02
      Estradiol 25 Oestrogens and Hormone Replacement Therapy 129 0.19 0.47 0.14 -1.98