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Prototype Prescribing Outlier Dashboard for Prentis Medical 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 Prentis Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Magnesium carbonate 4 Antacids and simeticone 4 1.00 0.00 0.05 19.28
Choline salicylate 3 Drugs for oral ulceration and inflammation 5 0.60 0.03 0.07 8.12
Hyoscine hydrobromide 67 Drugs used in nausea and vertigo 338 0.20 0.02 0.03 5.45
Hydrocortisone 6 Otitis externa 46 0.13 0.01 0.02 5.43
Phenylephrine hydrochloride 1 Mydriatics and cycloplegics 9 0.11 0.00 0.02 4.88
Paraffin soft white 6 Emollients 237 0.03 0.00 0.01 4.67
Iron and folic acid 33 Oral iron 1,355 0.02 0.00 0.01 3.69
Pneumococcal 31 Vaccines and antisera 55 0.56 0.05 0.14 3.62
Trimipramine maleate 16 Tricyclic and related antidepressant drugs 995 0.02 0.00 0.00 3.62
Clindamycin phosphate 11 Topical preparations for acne 43 0.26 0.06 0.06 3.45

Prescribing where Prentis Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Influenza 0 Vaccines and antisera 55 0.00 0.88 0.28 -3.13
    Potassium permanganate 2 Oxidisers and dyes 8 0.25 0.94 0.22 -3.10
    Benzydamine hydrochloride 2 Drugs for oral ulceration and inflammation 5 0.40 0.84 0.16 -2.77
    Simple 1 Expectorant and demulcent cough preparations 2 0.50 0.96 0.17 -2.72
    Fluconazole 8 Triazole antifungals 15 0.53 0.85 0.13 -2.39
    Sildenafil (Erectile Dysfunction) 117 Drugs for erectile dysfunction 205 0.57 0.77 0.09 -2.13
    Zopiclone 208 Hypnotics 664 0.31 0.60 0.14 -2.10
    Hydrocortisone 1 Copound haemorrhoidal preparations with corticosteroid 15 0.07 0.57 0.24 -2.07
    Spironolactone 121 Potassium-sparing diuretics and aldosterone antagonists 262 0.46 0.72 0.14 -1.87
    Cyclizine hydrochloride 11 Drugs used in nausea and vertigo 338 0.03 0.17 0.07 -1.86