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Prototype Prescribing Outlier Dashboard for St George & Riverside Medical 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 St George & Riverside Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Raloxifene hydrochloride 43 Oestrogens and Hormone Replacement Therapy 173 0.25 0.01 0.03 9.25
Lithium citrate 8 Drugs used for mania and hypomania 37 0.22 0.01 0.03 8.03
Oxytetracycline 246 Tetracyclines 627 0.39 0.05 0.05 7.17
Methyl salicylate 71 Rubefacients, topical NSAIDS, capsaicin and poultice 862 0.08 0.00 0.01 6.72
Trazodone hydrochloride 1,096 Tricyclic and related antidepressant drugs 2,900 0.38 0.06 0.06 5.42
Temazepam 150 Hypnotics 380 0.39 0.09 0.07 4.40
Aripiprazole 7 Antipsychotic depot injections 8 0.88 0.08 0.21 3.80
Beclometdiprop/formoterol/glycopyrronium 720 Selective beta(2)-agonists 3,452 0.21 0.06 0.04 3.57
Nicotine bitartrate 7 Nicotine dependence 67 0.10 0.00 0.03 3.57
Brinzolamide and timolol 46 Treatment of glaucoma 520 0.09 0.02 0.02 3.50

Prescribing where St George & Riverside Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Zopiclone 12 Hypnotics 380 0.03 0.60 0.14 -4.13
Amitriptyline hydrochloride 1,670 Tricyclic and related antidepressant drugs 2,900 0.58 0.84 0.08 -3.51
Salbutamol 2,701 Selective beta(2)-agonists 3,452 0.78 0.91 0.04 -2.78
Co-codamol (Codeine phosphate/paracetamol) 262 Non-opioid analgesics and compound preparations 3,586 0.07 0.45 0.15 -2.46
Estradiol 27 Oestrogens and Hormone Replacement Therapy 173 0.16 0.47 0.14 -2.26
Budesonide 0 Corticosteroids 7 0.00 0.71 0.32 -2.21
    Potassium permanganate 1 Oxidisers and dyes 2 0.50 0.94 0.22 -1.98
    Moxonidine 0 Centrally-acting antihypertensive drugs 29 0.00 0.65 0.33 -1.95
      Timolol and bimatoprost 0 Treatment of glaucoma 520 0.00 0.10 0.05 -1.93
        Omeprazole 1,621 Proton pump inhibitors 8,768 0.18 0.50 0.16 -1.93