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Prototype Prescribing Outlier Dashboard for Middle Chare Medical Group

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 Middle Chare Medical Group is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Indacaterol/mometasone 1 Corticosteroids (respiratory) 3,060 0.00 0.00 0.00 8.57
Flupentixol hydrochloride 99 Antipsychotic drugs 1,653 0.06 0.00 0.01 6.85
Acebutolol hydrochloride 27 Beta-adrenoceptor blocking drugs 7,669 0.00 0.00 0.00 5.90
Balsalazide sodium 73 Aminosalicylates 480 0.15 0.02 0.03 4.06
Prochlorperazine mesilate 14 Drugs used in nausea and vertigo 770 0.02 0.00 0.00 3.89
Methenamine hippurate 157 Urinary-tract infections 599 0.26 0.04 0.06 3.82
Ertugliflozin 16 Other antidiabetic drugs 1,225 0.01 0.00 0.00 3.57
Levonorgestrel 17 Oral progestogen-only contraceptives 245 0.07 0.01 0.02 3.36
Trazodone hydrochloride 831 Tricyclic and related antidepressant drugs 3,254 0.26 0.06 0.06 3.33
Nabumetone 16 Non-steroidal anti-inflammatory drugs 987 0.02 0.00 0.00 2.95

Prescribing where Middle Chare Medical Group is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nitrofurantoin 442 Urinary-tract infections 599 0.74 0.96 0.06 -3.82
Co-codamol (Codeine phosphate/paracetamol) 214 Non-opioid analgesics and compound preparations 4,846 0.04 0.45 0.15 -2.65
Citalopram hydrobromide 853 Selective serotonin re-uptake inhibitors 8,008 0.11 0.32 0.08 -2.53
Other multivitamin preparations 137 Multivitamin preparations 428 0.32 0.82 0.21 -2.43
Glycopyrronium bromide 0 Antimuscarinic drugs 9 0.00 0.82 0.35 -2.34
    Amitriptyline hydrochloride 2,214 Tricyclic and related antidepressant drugs 3,254 0.68 0.84 0.08 -2.12
    Midazolam hydrochloride 1 Drugs used in status epilepticus 5 0.20 0.80 0.28 -2.11
    Mesalazine (Systemic) 171 Aminosalicylates 480 0.36 0.65 0.15 -2.01
    Senna 490 Stimulant laxatives 1,783 0.27 0.55 0.14 -2.00
    Methylphenidate hydrochloride 37 CNS Stimulants and drugs used for ADHD 153 0.24 0.65 0.20 -2.00