Skip to main content

Prototype Prescribing Outlier Dashboard for Upminster Bridge 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 Upminster Bridge Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Inosine pranobex 5 Herpes simplex and varicella-zoster 52 0.10 0.00 0.00 64.26
Ketotifen fumarate 7 Antihistamines 313 0.02 0.00 0.00 10.39
Oxycodone hydrochloride/naloxone hydrochloride 21 Opioid analgesics 456 0.05 0.00 0.00 9.31
Meptazinol hydrochloride 41 Opioid analgesics 456 0.09 0.00 0.01 8.27
Dexamethasone sodium metasulphobenzoate 51 Otitis externa 119 0.43 0.04 0.05 7.05
Flupentixol hydrochloride 8 Antipsychotic drugs 143 0.06 0.00 0.01 6.37
Glycopyrronium bromide 66 Antimuscarinic bronchodilators 113 0.58 0.06 0.10 5.30
Ofloxacin 12 Antibacterials 76 0.16 0.01 0.03 5.05
Hydrocortisone acetate 15 Otitis externa 119 0.13 0.02 0.02 4.65
Insulin detemir 70 Intermediate and long-acting insulins 161 0.43 0.11 0.08 4.09

Prescribing where Upminster Bridge Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Permethrin 0 Parasiticidal preparations 1 0.00 0.83 0.24 -3.46
    Water for injection 0 Electrolytes and water 3 0.00 0.82 0.25 -3.33
      Dexamethasone 50 Otitis externa 119 0.42 0.78 0.12 -2.92
      Theophylline 6 Theophylline 12 0.50 0.91 0.17 -2.48
      Tiotropium bromide 32 Antimuscarinic bronchodilators 113 0.28 0.71 0.18 -2.38
      Quetiapine 9 Antipsychotic drugs 143 0.06 0.35 0.12 -2.36
      Mercaptopurine 0 Antimetabolites 3 0.00 0.80 0.35 -2.32
        Codeine phosphate 0 Cough suppressants 2 0.00 0.74 0.33 -2.22
          Alendronic acid 75 Bisphosphonates and other drugs 112 0.67 0.87 0.09 -2.20
          Benzydamine hydrochloride 7 Drugs for oral ulceration and inflammation 14 0.50 0.84 0.16 -2.15