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Prototype Prescribing Outlier Dashboard for The Practice Leecon Way

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 Practice Leecon Way is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Quinapril hydrochloride with diuretic 8 Angiotensin-converting enzyme inhibitors 2,072 0.00 0.00 0.00 44.16
Ciclosporin 7 Tear deficiency, eye lubricant/astringent 93 0.08 0.00 0.00 20.10
Simvastatin and ezetimibe 39 Lipid-regulating drugs 3,478 0.01 0.00 0.00 18.02
Paraffin soft yellow 14 Tear deficiency, eye lubricant/astringent 93 0.15 0.01 0.02 8.77
Levomepromazine maleate 32 Antipsychotic drugs 519 0.06 0.00 0.01 8.01
Calcitriol 7 Preparations for psoriasis 36 0.19 0.01 0.02 7.51
Clemastine fumarate 2 Antihistamines 942 0.00 0.00 0.00 5.24
Degarelix 15 Prostate cancer and gonadorelin analogues 36 0.42 0.03 0.07 5.24
Lidocaine 9 Local anaesthetics 16 0.56 0.07 0.11 4.59
Guanfacine 26 CNS Stimulants and drugs used for ADHD 110 0.24 0.02 0.05 4.24

Prescribing where The Practice Leecon Way is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lidocaine hydrochloride 7 Local anaesthetics 16 0.44 0.90 0.13 -3.47
Baclofen 37 Skeletal muscle relaxants 153 0.24 0.83 0.18 -3.23
Ispaghula husk 12 Bulk-forming laxatives 16 0.75 0.96 0.07 -2.95
Other multivitamin preparations 9 Multivitamin preparations 41 0.22 0.82 0.21 -2.92
Calcipotriol 25 Preparations for psoriasis 36 0.69 0.87 0.08 -2.20
Warfarin sodium 8 Oral anticoagulants 771 0.01 0.24 0.11 -2.09
Folic acid 216 Drugs used in megaloblastic anaemias 586 0.37 0.69 0.16 -2.06
Methotrexate 15 Rheumatic disease suppressant drugs 57 0.26 0.58 0.15 -2.02
Methylphenidate hydrochloride 29 CNS Stimulants and drugs used for ADHD 110 0.26 0.65 0.20 -1.89
Mirtazapine 569 Other antidepressant drugs 1,526 0.37 0.57 0.10 -1.85