Skip to main content

Prototype Prescribing Outlier Dashboard for The New 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 The New Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Loprazolam mesilate 24 Hypnotics 320 0.08 0.00 0.01 11.21
Co-phenotrope (Diphenox hydrochloride/atropine sulfate) 7 Antimotility drugs 160 0.04 0.00 0.00 9.46
Chlordiazepoxide hydrochloride 35 Anxiolytics 298 0.12 0.01 0.02 7.18
Verapamil hydrochloride 339 Calcium-channel blockers 4,560 0.07 0.01 0.01 6.45
Phentolamine/aviptadil 13 Drugs for erectile dysfunction 585 0.02 0.00 0.00 5.25
Simvastatin and ezetimibe 31 Lipid-regulating drugs 9,233 0.00 0.00 0.00 5.21
Cefuroxime axetil 5 Cephalosporins 47 0.11 0.00 0.02 4.65
Dicycloverine hydrochloride 44 Antispasmodic and other drugs altering gut motility 676 0.07 0.01 0.01 4.55
Trandolapril 58 Angiotensin-converting enzyme inhibitors 5,058 0.01 0.00 0.00 3.22
Ibandronic acid 80 Bisphosphonates and other drugs 636 0.13 0.02 0.03 3.11

Prescribing where The New Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Loperamide hydrochloride 153 Antimotility drugs 160 0.96 1.00 0.01 -3.88
Omeprazole 1,376 Proton pump inhibitors 9,205 0.15 0.50 0.16 -2.15
Zopiclone 102 Hypnotics 320 0.32 0.60 0.14 -2.06
Gliclazide 539 Sulfonylureas 794 0.68 0.93 0.13 -1.84
Hydrocortisone acetate 0 Topical corticosteroids 737 0.00 0.04 0.03 -1.63
    Prednisolone 5 Copound haemorrhoidal preparations with corticosteroid 85 0.06 0.43 0.24 -1.55
    Venlafaxine 302 Other antidepressant drugs 2,500 0.12 0.26 0.09 -1.53
    Sildenafil (Erectile Dysfunction) 368 Drugs for erectile dysfunction 585 0.63 0.77 0.09 -1.49
    Tamoxifen citrate 13 Breast cancer 189 0.07 0.27 0.14 -1.48
    Amiodarone hydrochloride 11 Drugs for arrhythmias 107 0.10 0.48 0.25 -1.48