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Prototype Prescribing Outlier Dashboard for The Willows Medical Ctr.

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 The Willows Medical Ctr. is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Torasemide 70 Loop diuretics 1,193 0.06 0.00 0.00 12.06
Gemfibrozil 30 Lipid-regulating drugs 7,764 0.00 0.00 0.00 10.73
Co-fluampicil(Flucloxacillin/ampicillin) 8 Broad-spectrum penicillins 890 0.01 0.00 0.00 9.54
Risedronate sodium 508 Bisphosphonates and other drugs 771 0.66 0.09 0.08 7.01
Guaifenesin 1 Expectorant and demulcent cough preparations 1 1.00 0.03 0.14 6.78
Glimepiride 674 Sulfonylureas 721 0.93 0.07 0.13 6.47
Quinagolide hydrochloride 11 Bromocriptine and other dopaminergic drugs 11 1.00 0.04 0.16 6.18
Flupentixol hydrochloride 55 Antipsychotic drugs 1,036 0.05 0.00 0.01 6.03
Levothyroxine sodium and liothyronine 7 Thyroid hormones 3,336 0.00 0.00 0.00 5.56
Tacalcitol 9 Preparations for psoriasis 99 0.09 0.00 0.02 5.42

Prescribing where The Willows Medical Ctr. is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Alendronic acid 189 Bisphosphonates and other drugs 771 0.25 0.87 0.09 -6.83
Gliclazide 47 Sulfonylureas 721 0.07 0.93 0.13 -6.41
Simple 0 Expectorant and demulcent cough preparations 1 0.00 0.96 0.17 -5.69
    Other amino acidandnutritional agent preparations 0 Amino acids and nutritional agents 3 0.00 0.96 0.19 -5.06
      Cabergoline 0 Bromocriptine and other dopaminergic drugs 11 0.00 0.86 0.27 -3.17
        Furosemide 765 Loop diuretics 1,193 0.64 0.85 0.09 -2.39
        Omeprazole 1,004 Proton pump inhibitors 8,491 0.12 0.50 0.16 -2.35
        Bendroflumethiazide 328 Thiazides and related diuretics 1,613 0.20 0.57 0.16 -2.32
        Beclometasone dipropionate 651 Corticosteroids (respiratory) 2,067 0.31 0.58 0.12 -2.27
        Theophylline 37 Theophylline 67 0.55 0.91 0.17 -2.17