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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Demeclocycline hydrochloride 20 Tetracyclines 240 0.08 0.00 0.01 14.46
Hydrocortisone 13 Otitis externa 67 0.19 0.01 0.02 8.27
Liquid paraffin 12 Emollient bath and shower preparations 26 0.46 0.03 0.07 6.13
Safinamide 34 Dopaminergic drugs used in parkinsonism 371 0.09 0.00 0.02 5.75
Gluten free/low protein drink 1 Foods for special diets 135 0.01 0.00 0.00 4.90
Lixisenatide 12 Other antidiabetic drugs 438 0.03 0.00 0.01 4.68
Soluble insulin (Neutral insulin) 11 Short-acting insulins 104 0.11 0.01 0.02 4.21
Liothyronine sodium 22 Thyroid hormones 1,748 0.01 0.00 0.00 3.98
Celecoxib 170 Non-steroidal anti-inflammatory drugs 1,001 0.17 0.03 0.04 3.81
Aclidinium bromide 75 Antimuscarinic bronchodilators 285 0.26 0.04 0.07 3.31

Prescribing where Nelson Medical Group is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Levothyroxine sodium 1,726 Thyroid hormones 1,748 0.99 1.00 0.00 -3.87
Tiotropium bromide 41 Antimuscarinic bronchodilators 285 0.14 0.71 0.18 -3.16
Hypromellose 19 Tear deficiency, eye lubricant/astringent 168 0.11 0.45 0.15 -2.21
Moxonidine 0 Centrally-acting antihypertensive drugs 41 0.00 0.65 0.33 -1.95
    Co-codamol (Codeine phosphate/paracetamol) 309 Non-opioid analgesics and compound preparations 1,884 0.16 0.45 0.15 -1.87
    Levetiracetam 62 Control of epilepsy 2,747 0.02 0.09 0.04 -1.84
    Calcipotriol 76 Preparations for psoriasis 105 0.72 0.87 0.08 -1.84
    Dexamethasone 38 Otitis externa 67 0.57 0.78 0.12 -1.74
    Prochlorperazine maleate 58 Drugs used in nausea and vertigo 562 0.10 0.25 0.08 -1.73
    Mometasone furoate 0 Topical corticosteroids 471 0.00 0.07 0.04 -1.72