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Prototype Prescribing Outlier Dashboard for Willow Practice

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 Willow Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Paraffin soft white 5 Emollients 95 0.05 0.00 0.01 10.08
Pridinol mesilate 5 Skeletal muscle relaxants 37 0.14 0.00 0.01 9.88
Selegiline hydrochloride 9 Dopaminergic drugs used in parkinsonism 72 0.12 0.00 0.01 8.64
Estradiol and nomegestrol 3 Combined hormonal contraceptives 121 0.02 0.00 0.00 7.79
Estradiol valandestradiol valerate with dienogest 3 Combined hormonal contraceptives 121 0.02 0.00 0.00 7.25
Vigabatrin 8 Control of epilepsy 1,131 0.01 0.00 0.00 4.43
Bisacodyl 148 Stimulant laxatives 286 0.52 0.13 0.10 3.95
Tapentadol hydrochloride 41 Opioid analgesics 559 0.07 0.01 0.02 3.74
Gluten free mixes 16 Foods for special diets 47 0.34 0.05 0.08 3.49
Sulpiride 33 Antipsychotic drugs 558 0.06 0.01 0.01 3.45

Prescribing where Willow Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Bendroflumethiazide 27 Thiazides and related diuretics 388 0.07 0.57 0.16 -3.17
Calcium carbonate 7 Calcium supplements 13 0.54 0.95 0.13 -3.15
Combined ethinylestradiol 30mcg 74 Combined hormonal contraceptives 121 0.61 0.81 0.07 -2.76
Benzydamine hydrochloride 4 Drugs for oral ulceration and inflammation 9 0.44 0.84 0.16 -2.50
Medroxyprogesterone acetate 10 Parenteral progestogen-only contraceptives 20 0.50 0.88 0.15 -2.49
Oral rehydration salts 0 Oral sodium and water 36 0.00 0.71 0.29 -2.42
    Other multivitamin preparations 16 Multivitamin preparations 46 0.35 0.82 0.21 -2.29
    Nicorandil 9 Other antianginal drugs 118 0.08 0.50 0.20 -2.08
    Moxonidine 0 Centrally-acting antihypertensive drugs 9 0.00 0.65 0.33 -1.95
      Tacrolimus 10 Drugs affecting the immune response 23 0.43 0.81 0.19 -1.91