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Prototype Prescribing Outlier Dashboard for Morden Hill 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 Morden Hill Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Stiripentol 7 Control of epilepsy 1,437 0.00 0.00 0.00 7.59
Vigabatrin 16 Control of epilepsy 1,437 0.01 0.00 0.00 7.13
Inosine pranobex 1 Herpes simplex and varicella-zoster 101 0.01 0.00 0.00 6.58
Other HIV infection preparations 1 HIV infection 1 1.00 0.03 0.16 6.23
Trimipramine maleate 15 Tricyclic and related antidepressant drugs 566 0.03 0.00 0.00 6.15
Orphenadrine hydrochloride 12 Antimuscarinic drugs used in parkinsonism 63 0.19 0.01 0.03 5.77
Diclofenac potassium 11 Non-steroidal anti-inflammatory drugs 616 0.02 0.00 0.00 5.20
Methoxy polyethylene glycol-epoetin beta 1 Hypoplastic/haemolytic and renal anaemias 1 1.00 0.04 0.19 4.95
Glycopyrronium bromide 23 Antispasmodic and other drugs altering gut motility 141 0.16 0.02 0.03 4.94
Paraldehyde 5 Drugs used in status epilepticus 12 0.42 0.01 0.08 4.91

Prescribing where Morden Hill Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Influenza 0 Vaccines and antisera 15 0.00 0.88 0.28 -3.13
    Medroxyprogesterone acetate 12 Parenteral progestogen-only contraceptives 27 0.44 0.88 0.15 -2.85
    Co-amilofruse (Amiloride hydrochloride/frusemide) 0 Potassium sparing diuretics and compounds 27 0.00 0.69 0.33 -2.10
      Theophylline 4 Theophylline 7 0.57 0.91 0.17 -2.06
      Prednisolone 201 Use of corticosteroids 260 0.77 0.89 0.06 -1.97
      Neomycin sulfate 13 Nasal preparations for infection 22 0.59 0.84 0.14 -1.79
      Sulfasalazine 8 Aminosalicylates 99 0.08 0.33 0.14 -1.76
      Chlorhexidine gluconate 26 Mouth-washes, gargles and dentifrices 32 0.81 0.97 0.11 -1.51
      Isosorbide mononitrate 113 Nitrates 200 0.56 0.72 0.11 -1.45
      Doxazosin mesilate 346 Alpha-adrenoceptor blocking drugs 359 0.96 0.99 0.02 -1.39