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Prototype Prescribing Outlier Dashboard for Broadway Medical Centre

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 Broadway Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Alimemazine tartrate 15 Antihistamines 292 0.05 0.00 0.00 11.08
Gentamicin sulfate 27 Antibacterials 49 0.55 0.03 0.05 10.55
Acarbose 10 Other antidiabetic drugs 203 0.05 0.00 0.00 9.92
Propiverine hydrochloride 29 Drugs for urinary frequency enuresis and incontinence 354 0.08 0.00 0.01 9.13
Cinnarizine 48 Drugs used in nausea and vertigo 117 0.41 0.05 0.04 8.45
Tetracycline 4 Tetracyclines 47 0.09 0.01 0.01 7.86
Liquid paraffin 12 Emollient bath and shower preparations 22 0.55 0.03 0.07 7.33
Calcium carbonate 14 Compound Alginates and proprietary indigestion preparations 167 0.08 0.00 0.01 7.18
Hydrocortisone acetate 5 Otitis externa 28 0.18 0.02 0.02 6.86
Clomipramine hydrochloride 33 Tricyclic and related antidepressant drugs 309 0.11 0.01 0.02 6.06

Prescribing where Broadway Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Alginic acid compound preparations 153 Compound Alginates and proprietary indigestion preparations 167 0.92 1.00 0.01 -6.42
Chloramphenicol 15 Antibacterials 49 0.31 0.81 0.11 -4.63
Azathioprine 0 Antiproliferative immunosuppressants 7 0.00 0.80 0.19 -4.32
    Trimethoprim 26 Sulfonamides and trimethoprim 65 0.40 0.87 0.12 -3.86
    Tiotropium bromide 4 Antimuscarinic bronchodilators 82 0.05 0.71 0.18 -3.69
    Potassium citrate 0 Drugs used in urological pain 1 0.00 0.92 0.25 -3.67
      Finasteride 39 Male sex hormones and antagonists 88 0.44 0.82 0.11 -3.30
      Mesalazine (Systemic) 11 Aminosalicylates 60 0.18 0.65 0.15 -3.20
      Co-codamol (Codeine phosphate/paracetamol) 36 Non-opioid analgesics and compound preparations 877 0.04 0.45 0.15 -2.67
      Clarithromycin 21 Macrolides 115 0.18 0.57 0.16 -2.44