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Prototype Prescribing Outlier Dashboard for Crouch Hall Road 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 Crouch Hall Road Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydromorphone hydrochloride 66 Opioid analgesics 663 0.10 0.00 0.00 83.45
Pethidine hydrochloride 54 Opioid analgesics 663 0.08 0.00 0.00 41.72
Belladonna alkaloids 10 Antispasmodic and other drugs altering gut motility 117 0.09 0.00 0.01 13.08
Metformin hydrochloride/pioglitazone 38 Other antidiabetic drugs 730 0.05 0.00 0.00 12.11
Oils for the ear 1 Removal of ear wax and other substances 1 1.00 0.01 0.10 9.75
Glycopyrronium/formoterol 4 Compound bronchodilator preparations 40 0.10 0.00 0.01 9.00
Diclofenac potassium 10 Non-steroidal anti-inflammatory drugs 363 0.03 0.00 0.00 8.20
Moxifloxacin 5 Quinolones 24 0.21 0.01 0.03 6.87
Glycopyrronium bromide 25 Antispasmodic and other drugs altering gut motility 117 0.21 0.02 0.03 6.65
Metolazone 22 Thiazides and related diuretics 694 0.03 0.00 0.00 6.57

Prescribing where Crouch Hall Road Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tamsulosin hydrochloride 288 Drugs for urinary retention 419 0.69 0.92 0.06 -3.92
Procyclidine hydrochloride 18 Antimuscarinic drugs used in parkinsonism 87 0.21 0.85 0.21 -3.09
Amoxicillin 251 Broad-spectrum penicillins 368 0.68 0.85 0.07 -2.53
Urea hydrogen peroxide 0 Removal of ear wax and other substances 1 0.00 0.83 0.33 -2.52
    Methotrexate 48 Rheumatic disease suppressant drugs 164 0.29 0.58 0.15 -1.83
    Coal tar 14 Shampoos and some other scalp preparations 107 0.13 0.40 0.15 -1.80
    Glyceryl trinitrate 32 Nitrates 375 0.09 0.27 0.10 -1.75
    Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 42 0.00 0.67 0.39 -1.73
      Solifenacin 41 Drugs for urinary frequency enuresis and incontinence 297 0.14 0.33 0.11 -1.71
      Hyoscine butylbromide 16 Antispasmodic and other drugs altering gut motility 117 0.14 0.33 0.12 -1.70