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Prototype Prescribing Outlier Dashboard for Kippax Hall 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 Kippax Hall Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Granisetron hydrochloride 5 Drugs used in nausea and vertigo 643 0.01 0.00 0.00 14.71
Glutaraldehyde 4 Preparations for warts and calluses 7 0.57 0.01 0.05 10.60
Omega-3-acid ethyl esters 114 Lipid-regulating drugs 6,673 0.02 0.00 0.00 7.56
Aluminium and magnesium and oxetacaine 5 Antacids and simeticone 5 1.00 0.04 0.15 6.42
Flavoxate hydrochloride 37 Drugs for urinary frequency enuresis and incontinence 1,013 0.04 0.00 0.01 6.31
Dexamfetamine sulfate 38 CNS Stimulants and drugs used for ADHD 91 0.42 0.03 0.06 5.93
Ferrous gluconate 177 Oral iron 521 0.34 0.03 0.05 5.84
Estradiol and nomegestrol 3 Combined hormonal contraceptives 176 0.02 0.00 0.00 5.27
Risperidone 3 Antipsychotic depot injections 3 1.00 0.08 0.21 4.44
Acetazolamide 43 Treatment of glaucoma 473 0.09 0.01 0.02 4.20

Prescribing where Kippax Hall Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
    Baclofen 178 Skeletal muscle relaxants 439 0.41 0.83 0.18 -2.33
    Tiotropium bromide 49 Antimuscarinic bronchodilators 156 0.31 0.71 0.18 -2.21
    Benzoyl peroxide and clindamycin phosphate 8 Topical preparations for acne 74 0.11 0.38 0.13 -1.99
    Doxazosin mesilate 727 Alpha-adrenoceptor blocking drugs 763 0.95 0.99 0.02 -1.96
    Tamsulosin hydrochloride 488 Drugs for urinary retention 601 0.81 0.92 0.06 -1.80
    Prednisolone 398 Use of corticosteroids 508 0.78 0.89 0.06 -1.79
    Dexamethasone 4 Corticosteroids 43 0.09 0.49 0.22 -1.77
    Gentamicin sulfate 0 Aminoglycosides 3 0.00 0.75 0.42 -1.77
      Quetiapine 67 Antipsychotic drugs 423 0.16 0.35 0.12 -1.58