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Prototype Prescribing Outlier Dashboard for Prasad

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 Prasad is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Diclofenac sod 2 Mouth-washes, gargles and dentifrices 3 0.67 0.00 0.00 410.80
Propafenone hydrochloride 7 Drugs for arrhythmias 12 0.58 0.02 0.05 10.59
Cyproheptadine hydrochloride 3 Antihistamines 243 0.01 0.00 0.00 10.07
Linezolid 3 Some other antibacterials 5 0.60 0.01 0.07 8.44
Enalapril maleate 427 Angiotensin-converting enzyme inhibitors 1,425 0.30 0.03 0.03 7.97
Irbesartan with diuretic 28 Angiotensin-II receptor antagonists 477 0.06 0.00 0.01 7.68
Ferric maltol 6 Oral iron 220 0.03 0.00 0.00 7.34
Hydrocort sodiumphos 5 Antibacterials 25 0.20 0.01 0.03 7.01
Sirolimus 28 Corticosteroids and other immunosuppressants 28 1.00 0.03 0.14 7.00
Canagliflozin/metformin 24 Other antidiabetic drugs 850 0.03 0.00 0.00 6.80

Prescribing where Prasad is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine gluconate 1 Mouth-washes, gargles and dentifrices 3 0.33 0.97 0.11 -6.02
Benzydamine hydrochloride 0 Drugs for oral ulceration and inflammation 1 0.00 0.84 0.16 -5.28
    Terbinafine hydrochloride 16 Other antifungals 19 0.84 0.99 0.03 -4.80
    Trimethoprim 13 Sulfonamides and trimethoprim 42 0.31 0.87 0.12 -4.62
    Ivermectin 0 Topical preparation for rosacea 3 0.00 0.88 0.22 -3.94
      Sertraline hydrochloride 218 Selective serotonin re-uptake inhibitors 1,232 0.18 0.46 0.09 -3.25
      Clarithromycin 5 Macrolides 54 0.09 0.57 0.16 -3.00
      Emollient bath and shower preparations 0 Emollient bath and shower preparations 1 0.00 0.63 0.21 -2.98
        Ketoconazole 1 Shampoos and some other scalp preparations 19 0.05 0.50 0.15 -2.92
        Tiotropium bromide 49 Antimuscarinic bronchodilators 218 0.22 0.71 0.18 -2.71