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Prototype Prescribing Outlier Dashboard for Mocketts Wood 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 Mocketts Wood Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dextromethorphan hydrobrom compound prepartions 1 Expectorant and demulcent cough preparations 4 0.25 0.00 0.01 33.46
Olmesartan medoxomil/amlodipine 295 Angiotensin-II receptor antagonists 3,133 0.09 0.00 0.00 31.35
Other bisphosphonate and other preparations 8 Bisphosphonates and other drugs 777 0.01 0.00 0.00 26.87
Olmesartan medoxomil/amlodipine/hydrochlorothiazide 157 Angiotensin-II receptor antagonists 3,133 0.05 0.00 0.00 17.16
Olmesartan medoxomil/hydrochlorothiazide 121 Angiotensin-II receptor antagonists 3,133 0.04 0.00 0.00 14.41
Oxazepam 223 Anxiolytics 843 0.26 0.01 0.02 10.96
Trimetazidine hydrochloride 5 Calcium-channel blockers 3,503 0.00 0.00 0.00 9.95
Cefuroxime axetil 20 Cephalosporins 111 0.18 0.00 0.02 8.02
Other osmotic laxative preparations 1 Osmotic laxatives 1,448 0.00 0.00 0.00 7.98
Ephedrine hydrochloride 15 Systemic nasal decongestants 16 0.94 0.03 0.16 5.74

Prescribing where Mocketts Wood Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pseudoephedrine hydrochloride 1 Systemic nasal decongestants 16 0.06 0.97 0.16 -5.74
Acamprosate calcium 0 Alcohol dependence 16 0.00 0.83 0.31 -2.69
    Amlodipine 1,721 Calcium-channel blockers 3,503 0.49 0.76 0.11 -2.35
    Prochlorperazine maleate 50 Drugs used in nausea and vertigo 921 0.05 0.25 0.08 -2.31
    Chloramphenicol 82 Antibacterials 139 0.59 0.81 0.11 -2.02
    Coal tar 9 Shampoos and some other scalp preparations 93 0.10 0.40 0.15 -2.02
    Sildenafil (Erectile Dysfunction) 251 Drugs for erectile dysfunction 429 0.59 0.77 0.09 -1.97
    Allopurinol 726 Gout and cytotoxic induced hyperiuicaemia 902 0.80 0.90 0.05 -1.78
    Hydrocortisone 232 Topical corticosteroids 1,011 0.23 0.34 0.06 -1.75
    Macrogol 3350 780 Osmotic laxatives 1,448 0.54 0.71 0.10 -1.74