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Prototype Prescribing Outlier Dashboard for The Heathcote Primary Care 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 The Heathcote Primary Care Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Indometacin 90 Non-steroidal anti-inflammatory drugs 457 0.20 0.01 0.01 15.60
Ofloxacin 17 Antibacterials 44 0.39 0.01 0.03 12.97
Apomorphine hydrochloride 8 Dopaminergic drugs used in parkinsonism 85 0.09 0.00 0.01 10.92
Hydrocortisone 15 Otitis externa 61 0.25 0.01 0.02 10.58
Rufinamide 5 Control of epilepsy 388 0.01 0.00 0.00 8.12
Combined ethinylestradiol 35mcg 47 Combined hormonal contraceptives 150 0.31 0.05 0.04 7.18
Piroxicam 53 Rubefacients, topical NSAIDS, capsaicin and poultice 77 0.69 0.05 0.09 7.18
Co-fluampicil(Flucloxacillin/ampicillin) 2 Broad-spectrum penicillins 298 0.01 0.00 0.00 7.08
Betamethasone esters 68 Topical corticosteroids 383 0.18 0.03 0.02 6.08
Clindamycin phosphate 6 Vaginal and vulval infections 24 0.25 0.03 0.04 5.87

Prescribing where The Heathcote Primary Care Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Furosemide 86 Loop diuretics 169 0.51 0.85 0.09 -3.87
Naproxen 149 Non-steroidal anti-inflammatory drugs 457 0.33 0.69 0.10 -3.64
Zopiclone 30 Hypnotics 150 0.20 0.60 0.14 -2.91
Combined ethinylestradiol 30mcg 91 Combined hormonal contraceptives 150 0.61 0.81 0.07 -2.83
Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
    Clotrimazole 1 Antifungal preparations 51 0.02 0.43 0.16 -2.54
    Sumatriptan succinate 24 Treatment of acute migraine 65 0.37 0.67 0.12 -2.51
    Levothyroxine sodium 574 Thyroid hormones 579 0.99 1.00 0.00 -2.47
    Sertraline hydrochloride 152 Selective serotonin re-uptake inhibitors 604 0.25 0.46 0.09 -2.38
    Clotrimazole 17 Vaginal and vulval infections 24 0.71 0.90 0.09 -2.26