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Prototype Prescribing Outlier Dashboard for The Cranborne 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 The Cranborne Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Indoramin 1 Alpha-adrenoceptor blocking drugs 1,173 0.00 0.00 0.00 51.44
Diphenhydramine hydrochloride 1 Topical local anaesthetics and antipruritics 59 0.02 0.00 0.00 10.88
Flubiprofen 2 Drugs for oral ulceration and inflammation 35 0.06 0.00 0.01 4.89
Ferrous gluconate 360 Oral iron 1,243 0.29 0.03 0.05 4.89
Ciclesonide 64 Corticosteroids (respiratory) 3,046 0.02 0.00 0.00 4.72
Sodium fusidate 57 Antibacterial preparations also used systemically 215 0.27 0.02 0.05 4.63
Frovatriptan 77 Treatment of acute migraine 534 0.14 0.02 0.03 4.34
Mizolastine 52 Antihistamines 2,486 0.02 0.00 0.00 4.05
Diltiazem hydrochloride 864 Calcium-channel blockers 6,021 0.14 0.05 0.03 3.56
Clomifene citrate 5 Hypothalamic & anterior pituitary hormone & antioestrogens 5 1.00 0.09 0.26 3.52

Prescribing where The Cranborne Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Somatropin 0 Hypothalamic & anterior pituitary hormone & antioestrogens 5 0.00 0.90 0.28 -3.25
    Gliclazide 399 Sulfonylureas 661 0.60 0.93 0.13 -2.40
    Mercaptopurine 0 Antimetabolites 77 0.00 0.80 0.35 -2.32
      Methylprednisolone acetate 1 Local corticosteroid injections 139 0.01 0.74 0.39 -1.87
      Sumatriptan succinate 241 Treatment of acute migraine 534 0.45 0.67 0.12 -1.82
      Ferrous fumarate 191 Oral iron 1,243 0.15 0.57 0.23 -1.78
      Losartan potassium 725 Angiotensin-II receptor antagonists 4,208 0.17 0.50 0.19 -1.77
      Aripiprazole 24 Antipsychotic drugs 875 0.03 0.13 0.06 -1.63
      Amiodarone hydrochloride 18 Drugs for arrhythmias 193 0.09 0.48 0.25 -1.52
      Levothyroxine sodium 4,681 Thyroid hormones 4,708 0.99 1.00 0.00 -1.44