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Prototype Prescribing Outlier Dashboard for Alexandra 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 Alexandra Surgery 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 454 0.07 0.00 0.00 18.17
Benzocaine 6 Drugs for oral ulceration and inflammation 31 0.19 0.00 0.02 12.54
Irbesartan with diuretic 80 Angiotensin-II receptor antagonists 1,068 0.07 0.00 0.01 9.91
Other magnesium preparations 4 Magnesium 6 0.67 0.01 0.07 9.76
Galantamine 92 Drugs for dementia 186 0.49 0.03 0.06 7.87
Zolpidem tartrate 154 Hypnotics 268 0.57 0.07 0.07 7.51
Dosulepin hydrochloride 89 Tricyclic and related antidepressant drugs 454 0.20 0.02 0.03 6.85
Betamethasone sodium phosphate 14 Use of corticosteroids 216 0.06 0.01 0.01 6.27
Metoprolol tartrate 99 Beta-adrenoceptor blocking drugs 1,598 0.06 0.01 0.01 6.09
Levodopa/carbidopa/entacapone 64 Dopaminergic drugs used in parkinsonism 224 0.29 0.03 0.04 5.80

Prescribing where Alexandra Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Permethrin 0 Parasiticidal preparations 2 0.00 0.83 0.24 -3.46
    Zopiclone 36 Hypnotics 268 0.13 0.60 0.14 -3.39
    Alendronic acid 87 Bisphosphonates and other drugs 154 0.56 0.87 0.09 -3.34
    Aciclovir 77 Herpes simplex and varicella-zoster 104 0.74 0.95 0.07 -3.21
    Beclometasone dipropionate 190 Corticosteroids (respiratory) 644 0.30 0.58 0.12 -2.45
    Amitriptyline hydrochloride 303 Tricyclic and related antidepressant drugs 454 0.67 0.84 0.08 -2.29
    Codeine phosphate 0 Cough suppressants 41 0.00 0.74 0.33 -2.22
      Neomycin sulfate 16 Nasal preparations for infection 29 0.55 0.84 0.14 -2.08
      Colecalciferol 826 Vitamin D 904 0.91 0.96 0.02 -2.03
      Donepezil hydrochloride 22 Drugs for dementia 186 0.12 0.49 0.18 -2.02