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Prototype Prescribing Outlier Dashboard for Whitehouse 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 Whitehouse Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Atenolol with calcium channel blocker 5 Beta-adrenoceptor blocking drugs 855 0.01 0.00 0.00 12.61
Telmisartan 144 Angiotensin-II receptor antagonists 662 0.22 0.01 0.02 9.17
Pimozide 2 Antipsychotic drugs 141 0.01 0.00 0.00 7.63
Benzalkonium chloride 5 Barrier preparations 5 1.00 0.05 0.14 6.77
Nortriptyline 59 Tricyclic and related antidepressant drugs 217 0.27 0.04 0.03 6.68
Benzalkonium chloride 5 Shampoos and some other scalp preparations 13 0.38 0.04 0.05 6.51
Ampicillin 1 Broad-spectrum penicillins 292 0.00 0.00 0.00 6.49
Nifedipine 152 Calcium-channel blockers 924 0.16 0.03 0.02 6.10
Levonorgestrel 8 Oral progestogen-only contraceptives 76 0.11 0.01 0.02 5.47
Metformin hydrochloride/sitagliptin 14 Other antidiabetic drugs 97 0.14 0.01 0.03 5.13

Prescribing where Whitehouse Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amitriptyline hydrochloride 125 Tricyclic and related antidepressant drugs 217 0.58 0.84 0.08 -3.50
Permethrin 0 Parasiticidal preparations 5 0.00 0.83 0.24 -3.46
    Sertraline hydrochloride 144 Selective serotonin re-uptake inhibitors 741 0.19 0.46 0.09 -3.05
    Procyclidine hydrochloride 2 Antimuscarinic drugs used in parkinsonism 9 0.22 0.85 0.21 -3.02
    Calcium carbonate 5 Calcium supplements 9 0.56 0.95 0.13 -3.02
    Desogestrel 59 Oral progestogen-only contraceptives 76 0.78 0.93 0.05 -2.92
    Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
      Atorvastatin 866 Lipid-regulating drugs 1,883 0.46 0.67 0.08 -2.58
      Pizotifen malate 0 Prophylaxis of migraine 12 0.00 0.63 0.26 -2.46
        Codeine phosphate 0 Cough suppressants 1 0.00 0.74 0.33 -2.22