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Prototype Prescribing Outlier Dashboard for Royal Primary Care Chesterfield West

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 Royal Primary Care Chesterfield West is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Oxitriptan 1 Other antidepressant drugs 3,745 0.00 0.00 0.00 9.65
Formoterol fumarate 113 Selective beta(2)-agonists 4,307 0.03 0.00 0.01 3.77
Ceftriaxone sodium 1 Cephalosporins 41 0.02 0.00 0.01 3.52
Light liquid paraffin 3 Emollient bath and shower preparations 3 1.00 0.34 0.20 3.24
Colistimethate sodium 14 Some other antibacterials 15 0.93 0.15 0.25 3.10
Empagliflozin 662 Other antidiabetic drugs 1,479 0.45 0.15 0.10 3.01
Lofepramine hydrochloride 157 Tricyclic and related antidepressant drugs 3,481 0.05 0.01 0.01 2.91
Glycopyrronium/formoterol 9 Compound bronchodilator preparations 286 0.03 0.00 0.01 2.70
Propiverine hydrochloride 31 Drugs for urinary frequency enuresis and incontinence 1,183 0.03 0.00 0.01 2.67
Atenolol 1,537 Beta-adrenoceptor blocking drugs 5,938 0.26 0.13 0.05 2.67

Prescribing where Royal Primary Care Chesterfield West is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Emollient bath and shower preparations 0 Emollient bath and shower preparations 3 0.00 0.63 0.21 -2.98
    Bisoprolol fumarate 2,719 Beta-adrenoceptor blocking drugs 5,938 0.46 0.65 0.08 -2.47
    Indapamide 140 Thiazides and related diuretics 1,863 0.08 0.43 0.16 -2.23
    Glucose blood testing reagents 772 Diabetic diagnostic and monitoring agents 885 0.87 0.94 0.03 -2.06
    Acamprosate calcium 13 Alcohol dependence 57 0.23 0.83 0.31 -1.95
    Hydralazine hydrochloride 4 Vasodilator antihypertensive drugs 11 0.36 0.85 0.28 -1.75
    Insulin glargine 79 Intermediate and long-acting insulins 771 0.10 0.33 0.13 -1.73
    Estradiol 43 Preparations for vaginal/vulval changes 224 0.19 0.55 0.20 -1.72
    Tacrolimus 0 Corticosteroids and other immunosuppressants 15 0.00 0.63 0.40 -1.58
      Apixaban 428 Oral anticoagulants 2,295 0.19 0.41 0.14 -1.57