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Prototype Prescribing Outlier Dashboard for London Road 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 London Road Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Doxepin 32 Tricyclic and related antidepressant drugs 545 0.06 0.00 0.00 15.08
Indoramin 28 Drugs for urinary retention 295 0.09 0.00 0.01 10.75
Celiprolol hydrochloride 25 Beta-adrenoceptor blocking drugs 2,191 0.01 0.00 0.00 7.33
Choline salicylate 7 Drugs for oral ulceration and inflammation 14 0.50 0.03 0.07 6.69
Alprostadil 29 Drugs for erectile dysfunction 207 0.14 0.02 0.02 5.03
Nitrazepam 32 Hypnotics 119 0.27 0.04 0.05 4.88
Cyproterone acetate 28 Prostate cancer and gonadorelin analogues 67 0.42 0.03 0.08 4.59
Diethylamine salicylate 74 Rubefacients, topical NSAIDS, capsaicin and poultice 255 0.29 0.03 0.06 4.54
Doxepin hydrochloride 1 Topical local anaesthetics and antipruritics 4 0.25 0.01 0.05 4.45
Fesoterodine fumarate 36 Drugs for urinary frequency enuresis and incontinence 212 0.17 0.03 0.04 3.94

Prescribing where London Road Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Desogestrel 45 Oral progestogen-only contraceptives 57 0.79 0.93 0.05 -2.68
Folic acid 204 Drugs used in megaloblastic anaemias 720 0.28 0.69 0.16 -2.60
Benzydamine hydrochloride 6 Drugs for oral ulceration and inflammation 14 0.43 0.84 0.16 -2.60
Nitrofurantoin 146 Urinary-tract infections 178 0.82 0.96 0.06 -2.44
Methotrexate 34 Rheumatic disease suppressant drugs 163 0.21 0.58 0.15 -2.38
Diazepam 41 Anxiolytics 91 0.45 0.75 0.13 -2.28
Baclofen 4 Skeletal muscle relaxants 9 0.44 0.83 0.18 -2.11
Estradiol 1 Preparations for vaginal/vulval changes 8 0.12 0.55 0.20 -2.05
Fexofenadine hydrochloride 76 Antihistamines 687 0.11 0.34 0.12 -1.98
Nicotine 0 Nicotine dependence 2 0.00 0.65 0.33 -1.95