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Prototype Prescribing Outlier Dashboard for The Old 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 The Old Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ciprofibrate 32 Lipid-regulating drugs 2,362 0.01 0.00 0.00 19.98
Pilocarpine hydrochloride 33 Treatment of glaucoma 238 0.14 0.00 0.01 19.37
Hydrocortisone 6 Otitis externa 23 0.26 0.01 0.02 11.25
Gentamicin sulfate 17 Antibacterials 33 0.52 0.03 0.05 9.82
Alfuzosin hydrochloride 76 Drugs for urinary retention 170 0.45 0.05 0.05 8.34
Cocois 8 Preparations for psoriasis 17 0.47 0.06 0.06 7.30
Clomipramine hydrochloride 32 Tricyclic and related antidepressant drugs 278 0.12 0.01 0.02 6.59
Lacosamide 18 Control of epilepsy 315 0.06 0.01 0.01 5.48
Erythromycin 10 Topical preparations for acne 16 0.62 0.12 0.09 5.35
Lactulose 152 Osmotic laxatives 194 0.78 0.28 0.10 5.28

Prescribing where The Old Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tamsulosin hydrochloride 90 Drugs for urinary retention 170 0.53 0.92 0.06 -6.59
Macrogol 3350 40 Osmotic laxatives 194 0.21 0.71 0.10 -5.20
Calcipotriol 9 Preparations for psoriasis 17 0.53 0.87 0.08 -4.25
Chloramphenicol 16 Antibacterials 33 0.48 0.81 0.11 -2.99
Allopurinol 49 Gout and cytotoxic induced hyperiuicaemia 65 0.75 0.90 0.05 -2.77
Morphine sulfate 1 Opioid analgesics 199 0.01 0.20 0.08 -2.55
Theophylline 16 Theophylline 32 0.50 0.91 0.17 -2.48
Pizotifen malate 0 Prophylaxis of migraine 33 0.00 0.63 0.26 -2.46
    Fexofenadine hydrochloride 26 Antihistamines 274 0.09 0.34 0.12 -2.11
    Betamethasone valerate 16 Topical corticosteroids 110 0.15 0.28 0.07 -2.05