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Prototype Prescribing Outlier Dashboard for Greenlands Surgery

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 Greenlands Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenytoin 6 Control of epilepsy 490 0.01 0.00 0.00 8.04
Valproic acid 7 Control of epilepsy 490 0.01 0.00 0.00 7.88
Oestrogens conjugated with progestogen 13 Oestrogens and Hormone Replacement Therapy 79 0.16 0.01 0.02 7.51
Rabeprazole sodium 66 Proton pump inhibitors 1,496 0.04 0.00 0.01 6.17
Minocycline hydrochloride 7 Tetracyclines 104 0.07 0.00 0.01 5.67
Ins degludec/liraglutide 6 Other antidiabetic drugs 209 0.03 0.00 0.00 5.51
Betamethasone sodium phosphate 17 Corticosteroids 19 0.89 0.18 0.15 4.93
Zuclopenthixol hydrochloride 7 Antipsychotic drugs 93 0.08 0.01 0.01 4.82
Meloxicam 97 Non-steroidal anti-inflammatory drugs 413 0.23 0.03 0.04 4.62
Indometacin 25 Non-steroidal anti-inflammatory drugs 413 0.06 0.01 0.01 4.26

Prescribing where Greenlands Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Coal tar 0 Shampoos and some other scalp preparations 13 0.00 0.40 0.15 -2.66
    Sertraline hydrochloride 228 Selective serotonin re-uptake inhibitors 941 0.24 0.46 0.09 -2.49
    Estradiol 12 Oestrogens and Hormone Replacement Therapy 79 0.15 0.47 0.14 -2.29
    Mirabegron 5 Drugs for urinary frequency enuresis and incontinence 197 0.03 0.23 0.09 -2.22
    Dexamethasone 0 Corticosteroids 19 0.00 0.49 0.22 -2.19
      Folic acid 110 Drugs used in megaloblastic anaemias 302 0.36 0.69 0.16 -2.09
      Risperidone 0 Antipsychotic drugs 93 0.00 0.15 0.08 -2.01
        Quinine sulfate 55 Antimalarials 88 0.62 0.90 0.14 -2.00
        Moxonidine 0 Centrally-acting antihypertensive drugs 12 0.00 0.65 0.33 -1.95
          Procyclidine hydrochloride 8 Antimuscarinic drugs used in parkinsonism 18 0.44 0.85 0.21 -1.94