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Prototype Prescribing Outlier Dashboard for Parkview 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 Parkview Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Diphenhydramine hydrochloride 101 Antihistamines 1,529 0.07 0.00 0.01 9.71
Atomoxetine hydrochloride 28 CNS Stimulants and drugs used for ADHD 37 0.76 0.08 0.11 6.20
Promethazine teoclate 43 Drugs used in nausea and vertigo 556 0.08 0.00 0.01 5.24
Ciprofloxacin 31 Antibacterials 83 0.37 0.05 0.06 5.23
Sodium valproate 670 Control of epilepsy 2,703 0.25 0.08 0.04 4.49
Tolfenamic acid 4 Treatment of acute migraine 126 0.03 0.00 0.01 4.12
Oxycodone hydrochloride/naloxone hydrochloride 18 Opioid analgesics 951 0.02 0.00 0.00 3.63
Tamsulosin and dutasteride hydrochloride 52 Drugs for urinary retention 400 0.13 0.02 0.03 3.60
Sterculia 25 Bulk-forming laxatives 85 0.29 0.04 0.07 3.59
Phenytoin 15 Control of epilepsy 2,703 0.01 0.00 0.00 3.45

Prescribing where Parkview Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ispaghula husk 60 Bulk-forming laxatives 85 0.71 0.96 0.07 -3.56
Baclofen 91 Skeletal muscle relaxants 240 0.38 0.83 0.18 -2.47
Donepezil hydrochloride 5 Drugs for dementia 127 0.04 0.49 0.18 -2.45
Vitamin A 0 Vitamin A 3 0.00 0.82 0.36 -2.28
    Prucalopride 0 Other drugs used in constipation 11 0.00 0.71 0.32 -2.19
      Chloramphenicol 48 Antibacterials 83 0.58 0.81 0.11 -2.13
      Methylphenidate hydrochloride 8 CNS Stimulants and drugs used for ADHD 37 0.22 0.65 0.20 -2.12
      Clotrimazole 34 Vaginal and vulval infections 47 0.72 0.90 0.09 -2.09
      Pizotifen malate 13 Prophylaxis of migraine 90 0.14 0.63 0.26 -1.89
      Sodium chloride 0 Topical nasal decongestants 4 0.00 0.54 0.30 -1.79