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Prototype Prescribing Outlier Dashboard for Sheffield 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 Sheffield Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Clomethiazole 7 Hypnotics 69 0.10 0.00 0.01 17.35
Deflazacort 7 Use of corticosteroids 174 0.04 0.00 0.00 11.76
Pilocarpine nitrate 7 Treatment of glaucoma 227 0.03 0.00 0.00 10.87
Ins degludec/liraglutide 15 Other antidiabetic drugs 460 0.03 0.00 0.00 6.30
Pilocarpine hydrochloride 10 Treatment of glaucoma 227 0.04 0.00 0.01 5.78
Selenium sulfide 6 Shampoos and some other scalp preparations 22 0.27 0.03 0.04 5.44
Emulsifying wax 13 Emollients 83 0.16 0.01 0.03 4.99
Tibolone 9 Oestrogens and Hormone Replacement Therapy 29 0.31 0.05 0.05 4.97
Citalopram hydrochloride 7 Selective serotonin re-uptake inhibitors 566 0.01 0.00 0.00 4.88
Atenolol 198 Beta-adrenoceptor blocking drugs 565 0.35 0.13 0.05 4.52

Prescribing where Sheffield Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other multivitamin preparations 0 Multivitamin preparations 7 0.00 0.82 0.21 -3.98
    Insulin aspart 36 Short-acting insulins 84 0.43 0.79 0.11 -3.20
    Trimethoprim 8 Sulfonamides and trimethoprim 16 0.50 0.87 0.12 -3.04
    Other emollient preparations 58 Emollients 83 0.70 0.89 0.07 -2.80
    Coal tar 0 Shampoos and some other scalp preparations 22 0.00 0.40 0.15 -2.66
      Estriol 0 Preparations for vaginal/vulval changes 3 0.00 0.45 0.20 -2.22
        Levetiracetam 10 Control of epilepsy 610 0.02 0.09 0.04 -2.00
        Tamoxifen citrate 0 Breast cancer 9 0.00 0.27 0.14 -1.99
          Hydrocortisone 54 Topical corticosteroids 251 0.22 0.34 0.06 -1.98
          Zinc oxide 3 Soothing haemorrhoidal preparations 11 0.27 0.77 0.26 -1.95