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Prototype Prescribing Outlier Dashboard for Highgrove 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 Highgrove Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tolnaftate 2 Antifungal preparations 120 0.02 0.00 0.00 29.70
Amoxicillin sodium 1 Broad-spectrum penicillins 827 0.00 0.00 0.00 21.73
Paracetamol combined preparations 17 Non-opioid analgesics and compound preparations 1,744 0.01 0.00 0.00 14.05
Low protein snacks 6 Foods for special diets 234 0.03 0.00 0.00 10.57
Fondaparinux sodium 1 Parenteral anticoagulants 3 0.33 0.00 0.03 10.45
Minocycline hydrochloride 32 Tetracyclines 290 0.11 0.00 0.01 9.54
Mianserin hydrochloride 3 Tricyclic and related antidepressant drugs 961 0.00 0.00 0.00 9.49
Oxycodone hydrochloride/naloxone hydrochloride 37 Opioid analgesics 973 0.04 0.00 0.00 7.63
Hyoscine hydrobromide 103 Drugs used in nausea and vertigo 443 0.23 0.02 0.03 6.48
Low protein meals 12 Foods for special diets 234 0.05 0.00 0.01 5.78

Prescribing where Highgrove Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ivermectin 0 Topical preparation for rosacea 5 0.00 0.88 0.22 -3.94
    Other emollient preparations 402 Emollients 590 0.68 0.89 0.07 -3.06
    Benzydamine hydrochloride 10 Drugs for oral ulceration and inflammation 21 0.48 0.84 0.16 -2.30
    Quinine sulfate 132 Antimalarials 219 0.60 0.90 0.14 -2.16
    Terbinafine hydrochloride 26 Other antifungals 28 0.93 0.99 0.03 -2.04
    Clotrimazole 12 Antifungal preparations 120 0.10 0.43 0.16 -2.04
    Doxycycline hyclate 133 Tetracyclines 290 0.46 0.70 0.12 -1.90
    Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 26 0.00 0.67 0.39 -1.73
      Pizotifen malate 21 Prophylaxis of migraine 104 0.20 0.63 0.26 -1.67
      Gabapentin 261 Control of epilepsy 2,549 0.10 0.24 0.08 -1.67