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Prototype Prescribing Outlier Dashboard for Heath Lane 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 Heath Lane Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Fulvestrant 16 Breast cancer 393 0.04 0.00 0.00 20.93
Nalmefene 4 Alcohol dependence 4 1.00 0.01 0.08 11.82
Pitolisant hydrochloride 8 CNS Stimulants and drugs used for ADHD 481 0.02 0.00 0.00 6.80
Nedocromil sodium 1 Other anti-inflammatory preparations 161 0.01 0.00 0.00 5.93
Sodium oxybate 8 Hypnotics 1,363 0.01 0.00 0.00 5.41
Ethosuximide 47 Control of epilepsy 4,304 0.01 0.00 0.00 3.98
Famciclovir 17 Herpes simplex and varicella-zoster 217 0.08 0.01 0.02 3.69
Eprosartan 126 Angiotensin-II receptor antagonists 5,909 0.02 0.00 0.01 3.60
Vardenafil 52 Drugs for erectile dysfunction 598 0.09 0.02 0.02 3.46
Sotalol hydrochloride 409 Beta-adrenoceptor blocking drugs 9,606 0.04 0.01 0.01 3.37

Prescribing where Heath Lane Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Acamprosate calcium 0 Alcohol dependence 4 0.00 0.83 0.31 -2.69
    Amoxicillin 572 Broad-spectrum penicillins 842 0.68 0.85 0.07 -2.57
    Prucalopride 1 Other drugs used in constipation 14 0.07 0.71 0.32 -1.97
    Mupirocin 0 Antibacterial preparations only used topically 7 0.00 0.64 0.36 -1.79
      Omeprazole 3,018 Proton pump inhibitors 14,443 0.21 0.50 0.16 -1.79
      Umeclidinium bromide/vilanterol 0 Compound bronchodilator preparations 152 0.00 0.50 0.30 -1.68
        Other emollient preparations 536 Emollients 682 0.79 0.89 0.07 -1.53
        Carbimazole 193 Antithyroid drugs 249 0.78 0.93 0.10 -1.52
        Naftidrofuryl oxalate 3 Peripheral vasodilators and related drugs 35 0.09 0.67 0.39 -1.51
        Clarithromycin 169 Macrolides 488 0.35 0.57 0.16 -1.42