Skip to main content

Prototype Prescribing Outlier Dashboard for King George 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 King George Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydrocortisone acetate 4 Corticosteroids 31 0.13 0.00 0.00 42.35
Pimozide 28 Antipsychotic drugs 1,817 0.02 0.00 0.00 8.31
Magnesium citrate 7 Bowel cleansing preparations 11 0.64 0.03 0.16 3.85
Betamethasone sodium phosphate 75 Otitis externa 304 0.25 0.03 0.06 3.73
Telmisartan 472 Angiotensin-II receptor antagonists 5,022 0.09 0.01 0.02 3.60
Frovatriptan 109 Treatment of acute migraine 928 0.12 0.02 0.03 3.41
Phentolamine/aviptadil 17 Drugs for erectile dysfunction 1,258 0.01 0.00 0.00 3.08
Doxycycline monohydrate 22 Tetracyclines 941 0.02 0.00 0.01 2.96
Bezafibrate 325 Lipid-regulating drugs 20,539 0.02 0.00 0.00 2.58
Oestrogens conjugated with progestogen 66 Oestrogens and Hormone Replacement Therapy 1,117 0.06 0.01 0.02 2.39

Prescribing where King George Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Fusidic acid 115 Antibacterial preparations also used systemically 231 0.50 0.75 0.14 -1.76
Nicotine 1 Nicotine dependence 12 0.08 0.65 0.33 -1.70
Dexamethasone 181 Otitis externa 304 0.60 0.78 0.12 -1.51
Medroxyprogesterone acetate 0 Progestogens 1 0.00 0.66 0.45 -1.46
    Ferrous fumarate 422 Oral iron 1,743 0.24 0.57 0.23 -1.40
    Sodium picosulfate 1 Bowel cleansing preparations 11 0.09 0.69 0.43 -1.40
    Zinc oxide 1 Barrier preparations 30 0.03 0.49 0.33 -1.39
    Clotrimazole 98 Vaginal and vulval infections 125 0.78 0.90 0.09 -1.39
    Fluticasone furoate 87 Drugs used in nasal allergy 1,612 0.05 0.22 0.13 -1.35
    Urea hydrogen peroxide 3 Removal of ear wax and other substances 7 0.43 0.83 0.33 -1.23