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Prototype Prescribing Outlier Dashboard for Cranham Health Centre

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 Cranham Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aspirin 32 Non-opioid analgesics and compound preparations 1,207 0.03 0.00 0.00 9.75
Tafluprost and timolol 33 Treatment of glaucoma 603 0.05 0.00 0.01 6.59
Liquid paraffin 22 Tear deficiency, eye lubricant/astringent 258 0.09 0.01 0.01 5.91
Glipizide 15 Sulfonylureas 265 0.06 0.00 0.01 5.76
Apomorphine hydrochloride 10 Dopaminergic drugs used in parkinsonism 216 0.05 0.00 0.01 5.25
Sodium zirconium cyclosilicate 1 Oral potassium 2 0.50 0.02 0.10 5.05
Lacosamide 64 Control of epilepsy 1,295 0.05 0.01 0.01 4.64
Fexofenadine hydrochloride 486 Antihistamines 559 0.87 0.34 0.12 4.48
Insulin detemir 101 Intermediate and long-acting insulins 224 0.45 0.11 0.08 4.29
Azelastine hydrochloride 9 Other anti-inflammatory preparations 24 0.38 0.06 0.08 4.19

Prescribing where Cranham Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium chloride 1 Oral potassium 2 0.50 0.96 0.14 -3.33
Sodium cromoglicate 3 Other anti-inflammatory preparations 24 0.12 0.64 0.19 -2.73
Levothyroxine sodium 1,836 Thyroid hormones 1,851 0.99 1.00 0.00 -2.28
Calcipotriol 30 Preparations for psoriasis 43 0.70 0.87 0.08 -2.16
Tiotropium bromide 89 Antimuscarinic bronchodilators 272 0.33 0.71 0.18 -2.13
Clotrimazole 18 Vaginal and vulval infections 25 0.72 0.90 0.09 -2.13
Pizotifen malate 6 Prophylaxis of migraine 63 0.10 0.63 0.26 -2.08
Ispaghula husk 18 Bulk-forming laxatives 22 0.82 0.96 0.07 -2.01
Procyclidine hydrochloride 7 Antimuscarinic drugs used in parkinsonism 16 0.44 0.85 0.21 -1.98
Cetirizine hydrochloride 40 Antihistamines 559 0.07 0.28 0.11 -1.96