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Prototype Prescribing Outlier Dashboard for Thornfield 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 Thornfield Medical Group is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tryptophan 38 Other antidepressant drugs 10,649 0.00 0.00 0.00 10.08
Balsalazide sodium 99 Aminosalicylates 476 0.21 0.02 0.03 5.74
Gentamicin sulfate 36 Antibacterials 115 0.31 0.03 0.05 5.71
Etodolac 152 Non-steroidal anti-inflammatory drugs 2,070 0.07 0.01 0.01 4.45
Ketoprofen 30 Non-steroidal anti-inflammatory drugs 2,070 0.01 0.00 0.00 4.21
Glycopyrronium bromide 638 Antimuscarinic bronchodilators 1,357 0.47 0.06 0.10 4.15
Glutaraldehyde 3 Preparations for warts and calluses 14 0.21 0.01 0.05 3.86
Gluten free/low protein grains/flours 5 Foods for special diets 212 0.02 0.00 0.01 3.83
Risperidone 28 Antipsychotic depot injections 33 0.85 0.08 0.21 3.71
Methenamine hippurate 158 Urinary-tract infections 626 0.25 0.04 0.06 3.66

Prescribing where Thornfield Medical Group is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nitrofurantoin 468 Urinary-tract infections 626 0.75 0.96 0.06 -3.66
Aspirin 4,954 Antiplatelet drugs 10,644 0.47 0.65 0.06 -3.07
Tiotropium bromide 272 Antimuscarinic bronchodilators 1,357 0.20 0.71 0.18 -2.84
Trimethoprim 201 Sulfonamides and trimethoprim 377 0.53 0.87 0.12 -2.76
Alendronic acid 1,133 Bisphosphonates and other drugs 1,769 0.64 0.87 0.09 -2.52
Clarithromycin 143 Macrolides 793 0.18 0.57 0.16 -2.46
Amitriptyline hydrochloride 3,841 Tricyclic and related antidepressant drugs 5,851 0.66 0.84 0.08 -2.44
Co-codamol (Codeine phosphate/paracetamol) 900 Non-opioid analgesics and compound preparations 9,091 0.10 0.45 0.15 -2.29
Ramipril 5,231 Angiotensin-converting enzyme inhibitors 15,693 0.33 0.69 0.17 -2.18
Zinc sulfate monohydrate 0 Zinc 2 0.00 0.74 0.39 -1.90