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Prototype Prescribing Outlier Dashboard for St Giles 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 St Giles Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Rupatadine fumarate 32 Antihistamines 574 0.06 0.00 0.00 58.90
Mefloquine hydrochloride 5 Antimalarials 183 0.03 0.00 0.00 14.84
Valsartan with diuretic 58 Angiotensin-II receptor antagonists 982 0.06 0.00 0.01 10.43
Phosphates (Rectal) 14 Osmotic laxatives 203 0.07 0.01 0.01 6.90
Valsartan 123 Angiotensin-II receptor antagonists 982 0.13 0.02 0.02 5.65
Typhoid 15 Vaccines and antisera 35 0.43 0.02 0.07 5.63
Flavoxate hydrochloride 21 Drugs for urinary frequency enuresis and incontinence 725 0.03 0.00 0.01 4.95
Febuxostat 43 Gout and cytotoxic induced hyperiuicaemia 285 0.15 0.02 0.03 4.65
Lacidipine 280 Calcium-channel blockers 2,090 0.13 0.01 0.03 4.47
Paraffin soft yellow 5 Tear deficiency, eye lubricant/astringent 65 0.08 0.01 0.02 4.28

Prescribing where St Giles Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Trimethoprim 32 Sulfonamides and trimethoprim 66 0.48 0.87 0.12 -3.16
Influenza 0 Vaccines and antisera 35 0.00 0.88 0.28 -3.13
    Hypromellose 5 Tear deficiency, eye lubricant/astringent 65 0.08 0.45 0.15 -2.45
    Medroxyprogesterone acetate 17 Parenteral progestogen-only contraceptives 33 0.52 0.88 0.15 -2.39
    Pizotifen malate 2 Prophylaxis of migraine 35 0.06 0.63 0.26 -2.23
    Codeine phosphate 0 Cough suppressants 1 0.00 0.74 0.33 -2.22
      Macrogol 3350 101 Osmotic laxatives 203 0.50 0.71 0.10 -2.17
      Quinine sulfate 111 Antimalarials 183 0.61 0.90 0.14 -2.13
      Sodium cromoglicate 11 Other anti-inflammatory preparations 45 0.24 0.64 0.19 -2.10
      Neomycin sulfate 11 Nasal preparations for infection 19 0.58 0.84 0.14 -1.88