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Prototype Prescribing Outlier Dashboard for Desford Medical Centre

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 Desford Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ibandronic acid 153 Bisphosphonates and other drugs 426 0.36 0.02 0.03 10.29
Chlohexidine gluconate (Emollient) 3 Emollients 233 0.01 0.00 0.00 7.87
Diclofenac sodium 3 Ocular diagnostic & peri-operative prepn & photodynamic tt 3 1.00 0.03 0.12 7.83
Miconazole nitrate 11 Vaginal and vulval infections 52 0.21 0.01 0.03 5.81
Testosterone enantate 14 Male sex hormones and antagonists 401 0.03 0.00 0.01 5.42
Triptorelin acetate 20 Prostate cancer and gonadorelin analogues 59 0.34 0.02 0.06 5.38
Haloperidol 53 Antipsychotic drugs 294 0.18 0.03 0.03 5.19
Sodium picosulfate 72 Stimulant laxatives 345 0.21 0.03 0.03 5.18
Fluticasone propionate (Topical) 4 Topical corticosteroids 510 0.01 0.00 0.00 5.15
Lacidipine 404 Calcium-channel blockers 2,766 0.15 0.01 0.03 4.91

Prescribing where Desford Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nitrofurantoin 171 Urinary-tract infections 225 0.76 0.96 0.06 -3.45
Clotrimazole 34 Vaginal and vulval infections 52 0.65 0.90 0.09 -2.89
Alendronic acid 261 Bisphosphonates and other drugs 426 0.61 0.87 0.09 -2.82
Sumatriptan succinate 80 Treatment of acute migraine 223 0.36 0.67 0.12 -2.59
Zinc oxide 1 Soothing haemorrhoidal preparations 8 0.12 0.77 0.26 -2.52
Aspirin 821 Antiplatelet drugs 1,610 0.51 0.65 0.06 -2.32
Naproxen 279 Non-steroidal anti-inflammatory drugs 606 0.46 0.69 0.10 -2.30
Folic acid 244 Drugs used in megaloblastic anaemias 735 0.33 0.69 0.16 -2.30
Amoxicillin 438 Broad-spectrum penicillins 618 0.71 0.85 0.07 -2.14
Benzoyl peroxide and clindamycin phosphate 7 Topical preparations for acne 66 0.11 0.38 0.13 -2.00