Skip to main content

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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Rabeprazole sodium 628 Proton pump inhibitors 4,731 0.13 0.00 0.01 20.00
Imipramine hydrochloride 188 Tricyclic and related antidepressant drugs 1,404 0.13 0.01 0.01 12.71
Dicycloverine hydrochloride compound preparations 51 Antispasmodic and other drugs altering gut motility 455 0.11 0.00 0.01 11.44
Lixisenatide 34 Other antidiabetic drugs 688 0.05 0.00 0.01 8.72
Indometacin 196 Non-steroidal anti-inflammatory drugs 1,858 0.11 0.01 0.01 8.00
Ferrous gluconate 137 Oral iron 362 0.38 0.03 0.05 6.58
Sodium picosulfate 47 Stimulant laxatives 185 0.25 0.03 0.03 6.48
Nefopam hydrochloride 332 Non-opioid analgesics and compound preparations 2,899 0.11 0.01 0.02 5.94
Glycerol 36 Stimulant laxatives 185 0.19 0.04 0.03 5.49
Dosulepin hydrochloride 209 Tricyclic and related antidepressant drugs 1,404 0.15 0.02 0.03 4.96

Prescribing where Old School Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amitriptyline hydrochloride 744 Tricyclic and related antidepressant drugs 1,404 0.53 0.84 0.08 -4.12
Baclofen 279 Skeletal muscle relaxants 1,004 0.28 0.83 0.18 -3.03
Fluconazole 63 Triazole antifungals 130 0.48 0.85 0.13 -2.75
Tiotropium bromide 87 Antimuscarinic bronchodilators 364 0.24 0.71 0.18 -2.63
Other multivitamin preparations 93 Multivitamin preparations 328 0.28 0.82 0.21 -2.61
Naproxen 822 Non-steroidal anti-inflammatory drugs 1,858 0.44 0.69 0.10 -2.48
Sertraline hydrochloride 892 Selective serotonin re-uptake inhibitors 3,500 0.25 0.46 0.09 -2.35
Dexamethasone 70 Otitis externa 137 0.51 0.78 0.12 -2.19
Ramipril 1,077 Angiotensin-converting enzyme inhibitors 2,954 0.36 0.69 0.17 -1.99
Clobetasone butyrate 29 Topical corticosteroids 807 0.04 0.13 0.05 -1.97