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Prototype Prescribing Outlier Dashboard for Central 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 Central Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gentamicin sulfate 2 Antibacterial preparations also used systemically 203 0.01 0.00 0.00 37.27
Dexpanthenol 24 Emollients 541 0.04 0.00 0.01 6.73
Hyoscine 64 Drugs used in nausea and vertigo 632 0.10 0.02 0.02 3.48
Indacaterol/glycopyrronium 85 Compound bronchodilator preparations 106 0.80 0.15 0.20 3.28
Dapagliflozin 737 Other antidiabetic drugs 1,910 0.39 0.13 0.09 3.02
Aluminium and magnesium and activated simeticone 5 Antacids and simeticone 5 1.00 0.15 0.29 2.92
Indometacin 42 Non-steroidal anti-inflammatory drugs 951 0.04 0.01 0.01 2.90
Lidocaine 13 Local anaesthetics 37 0.35 0.07 0.11 2.64
Dronabinol/cannabidiol 6 Skeletal muscle relaxants 269 0.02 0.00 0.01 2.27
Lidocaine hydrochloride 1 Lozenges and sprays 1 1.00 0.19 0.38 2.16

Prescribing where Central Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lidocaine hydrochloride 24 Local anaesthetics 37 0.65 0.90 0.13 -1.90
Umeclidinium bromide/vilanterol 5 Compound bronchodilator preparations 106 0.05 0.50 0.30 -1.52
Water for injection 11 Electrolytes and water 24 0.46 0.82 0.25 -1.48
Hydrocortisone 380 Topical corticosteroids 1,495 0.25 0.34 0.06 -1.35
Colecalciferol 3,503 Vitamin D 3,761 0.93 0.96 0.02 -1.31
Gabapentin 505 Control of epilepsy 3,856 0.13 0.24 0.08 -1.31
Fluticasone furoate 54 Drugs used in nasal allergy 844 0.06 0.22 0.13 -1.27
Fluticasone propionate (Nasal) 29 Drugs used in nasal allergy 844 0.03 0.13 0.07 -1.26
Cyclizine hydrochloride 49 Drugs used in nausea and vertigo 632 0.08 0.17 0.07 -1.25
Esomeprazole 61 Proton pump inhibitors 10,132 0.01 0.03 0.02 -1.25