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Prototype Prescribing Outlier Dashboard for Wayside Medical Practice

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 Wayside Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Metformin hydrochloride/pioglitazone 36 Other antidiabetic drugs 472 0.08 0.00 0.00 17.87
Phenoxybenzamine hydrochloride 4 Alpha-adrenoceptor blocking drugs 264 0.02 0.00 0.00 17.34
Ramipril with calcium channel blocker 12 Angiotensin-converting enzyme inhibitors 1,625 0.01 0.00 0.00 11.35
Minoxidil 7 Shampoos and some other scalp preparations 57 0.12 0.00 0.01 10.30
Telmisartan with diuretic 32 Angiotensin-II receptor antagonists 800 0.04 0.00 0.00 9.85
Phenobarbital 93 Control of epilepsy 1,435 0.06 0.01 0.01 9.58
Glycopyrronium bromide 20 Antispasmodic and other drugs altering gut motility 83 0.24 0.02 0.03 7.57
Acipimox 2 Lipid-regulating drugs 2,467 0.00 0.00 0.00 6.65
Mebeverine hydrochloride compound preparations 11 Antispasmodic and other drugs altering gut motility 83 0.13 0.01 0.02 6.19
Diethylamine salicylate 58 Rubefacients, topical NSAIDS, capsaicin and poultice 154 0.38 0.03 0.06 6.03

Prescribing where Wayside Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium permanganate 1 Oxidisers and dyes 5 0.20 0.94 0.22 -3.33
Zinc oxide 0 Soothing haemorrhoidal preparations 1 0.00 0.77 0.26 -3.01
    Salicylic acid 0 Preparations for warts and calluses 4 0.00 0.67 0.31 -2.17
      Water for injection 5 Electrolytes and water 15 0.33 0.82 0.25 -1.98
      Moxonidine 0 Centrally-acting antihypertensive drugs 4 0.00 0.65 0.33 -1.95
        Solifenacin 31 Drugs for urinary frequency enuresis and incontinence 266 0.12 0.33 0.11 -1.90
        Ispaghula husk 111 Bulk-forming laxatives 132 0.84 0.96 0.07 -1.69
        Duloxetine hydrochloride 23 Other antidepressant drugs 686 0.03 0.15 0.07 -1.64
        Umeclidinium bromide/vilanterol 2 Compound bronchodilator preparations 100 0.02 0.50 0.30 -1.61
        Gabapentin 161 Control of epilepsy 1,435 0.11 0.24 0.08 -1.54