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Prototype Prescribing Outlier Dashboard for Highfield 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 Highfield Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Zuclopenthixol hydrochloride 258 Antipsychotic drugs 1,202 0.21 0.01 0.01 14.64
Apomorphine hydrochloride hemihydrate 6 Dopaminergic drugs used in parkinsonism 296 0.02 0.00 0.00 12.22
Nadolol 30 Beta-adrenoceptor blocking drugs 3,305 0.01 0.00 0.00 9.22
Metolazone 28 Thiazides and related diuretics 736 0.04 0.00 0.00 7.94
Tiagabine 4 Control of epilepsy 1,762 0.00 0.00 0.00 6.68
Nedocromil sodium 1 Cromoglycate and related therapy 1 1.00 0.03 0.15 6.42
Acitretin 10 Preparations for psoriasis 112 0.09 0.00 0.02 4.49
Quinagolide hydrochloride 2 Bromocriptine and other dopaminergic drugs 3 0.67 0.04 0.16 4.03
Bempedoic acid/Ezetimibe 3 Lipid-regulating drugs 4,799 0.00 0.00 0.00 3.80
Other zinc preparations 3 Zinc 5 0.60 0.03 0.15 3.75

Prescribing where Highfield Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium cromoglicate 0 Cromoglycate and related therapy 1 0.00 0.97 0.15 -6.42
    Calcium carbonate 5 Calcium supplements 9 0.56 0.95 0.13 -3.02
    Mebeverine hydrochloride 136 Antispasmodic and other drugs altering gut motility 827 0.16 0.45 0.12 -2.30
    Acamprosate calcium 2 Alcohol dependence 13 0.15 0.83 0.31 -2.19
    Isosorbide mononitrate 174 Nitrates 345 0.50 0.72 0.11 -2.02
    Cabergoline 1 Bromocriptine and other dopaminergic drugs 3 0.33 0.86 0.27 -1.94
    Codeine phosphate 1 Cough suppressants 10 0.10 0.74 0.33 -1.92
    Quetiapine 162 Antipsychotic drugs 1,202 0.13 0.35 0.12 -1.77
    Insulin aspart 101 Short-acting insulins 168 0.60 0.79 0.11 -1.68
    Dexamethasone 7 Corticosteroids 54 0.13 0.49 0.22 -1.61