Skip to main content

Prototype Prescribing Outlier Dashboard for Bellingham 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 Bellingham Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Paliperidone 6 Antipsychotic drugs 189 0.03 0.00 0.00 16.88
Methylcellulose 2 Bulk-forming laxatives 45 0.04 0.00 0.00 12.57
Paraffin soft yellow 1 Emollients 59 0.02 0.00 0.00 11.05
Tolbutamide 61 Sulfonylureas 542 0.11 0.00 0.01 10.77
Deflazacort 14 Use of corticosteroids 435 0.03 0.00 0.00 9.37
Azelaic acid 9 Topical preparations for acne 18 0.50 0.07 0.06 7.62
Amiloride hydrochloride 114 Potassium-sparing diuretics and aldosterone antagonists 369 0.31 0.03 0.04 6.92
Dronedarone hydrochloride 29 Drugs for arrhythmias 70 0.41 0.02 0.06 6.37
Pioglitazone hydrochloride 130 Other antidiabetic drugs 366 0.36 0.04 0.05 6.26
Guanfacine 17 CNS Stimulants and drugs used for ADHD 54 0.31 0.02 0.05 5.78

Prescribing where Bellingham Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Beclometasone dipropionate 220 Corticosteroids (respiratory) 939 0.23 0.58 0.12 -2.97
Tiotropium bromide 48 Antimuscarinic bronchodilators 189 0.25 0.71 0.18 -2.54
Pregabalin 99 Control of epilepsy 1,350 0.07 0.27 0.08 -2.50
Methylphenidate hydrochloride 8 CNS Stimulants and drugs used for ADHD 54 0.15 0.65 0.20 -2.46
Folic acid 253 Drugs used in megaloblastic anaemias 792 0.32 0.69 0.16 -2.37
Spironolactone 146 Potassium-sparing diuretics and aldosterone antagonists 369 0.40 0.72 0.14 -2.35
Glycopyrronium bromide 0 Antimuscarinic drugs 8 0.00 0.82 0.35 -2.34
    Co-codamol (Codeine phosphate/paracetamol) 154 Non-opioid analgesics and compound preparations 1,634 0.09 0.45 0.15 -2.32
    Lactulose 13 Osmotic laxatives 210 0.06 0.28 0.10 -2.27
    Indapamide 87 Thiazides and related diuretics 1,110 0.08 0.43 0.16 -2.21