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Prototype Prescribing Outlier Dashboard for The Dengie Medical Partnership

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 Dengie Medical Partnership is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gluten free/low protein bread 25 Foods for special diets 99 0.25 0.01 0.02 11.81
Gluten free/low protein biscuits 11 Foods for special diets 99 0.11 0.00 0.01 9.44
Sodium chloride 5 Tear deficiency, eye lubricant/astringent 49 0.10 0.00 0.01 8.10
Epinastine hydrochloride 4 Other anti-inflammatory preparations 46 0.09 0.00 0.01 7.68
Dithranol 3 Preparations for psoriasis 46 0.07 0.00 0.01 7.07
Gluten free/low protein pasta 11 Foods for special diets 99 0.11 0.00 0.02 6.14
Estradiol and estriol with progestogen 11 Oestrogens and Hormone Replacement Therapy 328 0.03 0.00 0.01 5.83
Olodaterol 4 Selective beta(2)-agonists 1,505 0.00 0.00 0.00 4.88
Moxifloxacin hydrochloride 1 Ocular diagnostic & peri-operative prepn & photodynamic tt 2 0.50 0.03 0.11 4.50
Azelastine hydrochloride 17 Other anti-inflammatory preparations 46 0.37 0.06 0.08 4.12

Prescribing where The Dengie Medical Partnership is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Oral rehydration salts 0 Oral sodium and water 3 0.00 0.71 0.29 -2.42
    Glycopyrronium bromide 0 Antimuscarinic drugs 7 0.00 0.82 0.35 -2.34
      Desogestrel 261 Oral progestogen-only contraceptives 313 0.83 0.93 0.05 -1.86
      Donepezil hydrochloride 27 Drugs for dementia 162 0.17 0.49 0.18 -1.76
      Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 9 0.00 0.67 0.39 -1.73
        Tiotropium bromide 105 Antimuscarinic bronchodilators 248 0.42 0.71 0.18 -1.60
        Estradiol 26 Preparations for vaginal/vulval changes 118 0.22 0.55 0.20 -1.59
        Chlorphenamine maleate 8 Antihistamines 975 0.01 0.06 0.04 -1.53
        Beclometasone dipropionate 36 Drugs used in nasal allergy 672 0.05 0.23 0.12 -1.51
        Zinc oxide 0 Barrier preparations 46 0.00 0.49 0.33 -1.49