Skip to main content

Prototype Prescribing Outlier Dashboard for The Watercress Medical Group

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 Watercress Medical Group is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chloramphenicol 2 Some other antibacterials 41 0.05 0.00 0.00 34.75
Dornase alfa 7 Mucolytics 86 0.08 0.00 0.01 8.32
Other eye tear/lubricant/astringent preparations 36 Tear deficiency, eye lubricant/astringent 225 0.16 0.01 0.02 7.26
Liothyronine sodium 70 Thyroid hormones 3,300 0.02 0.00 0.00 7.11
Deflazacort 15 Use of corticosteroids 770 0.02 0.00 0.00 5.59
Glycopyrronium bromide 1 Antiperspirants 4 0.25 0.00 0.05 5.45
Fluorescein sodium 3 Ocular diagnostic & peri-operative prepn & photodynamic tt 16 0.19 0.00 0.04 5.04
Low protein pastas 16 Foods for special diets 171 0.09 0.00 0.02 4.76
Hydrocortisone 14 Otitis externa 127 0.11 0.01 0.02 4.53
Miconazole nitrate 8 Vaginal and vulval infections 50 0.16 0.01 0.03 4.29

Prescribing where The Watercress Medical Group is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Levothyroxine sodium 3,226 Thyroid hormones 3,300 0.98 1.00 0.00 -7.35
Aluminium chloride 3 Antiperspirants 4 0.75 0.99 0.05 -5.14
Aciclovir 86 Herpes simplex and varicella-zoster 115 0.75 0.95 0.07 -3.10
Naproxen 445 Non-steroidal anti-inflammatory drugs 971 0.46 0.69 0.10 -2.32
Cabergoline 3 Bromocriptine and other dopaminergic drugs 10 0.30 0.86 0.27 -2.06
Losartan potassium 299 Angiotensin-II receptor antagonists 2,141 0.14 0.50 0.19 -1.95
Sumatriptan succinate 137 Treatment of acute migraine 300 0.46 0.67 0.12 -1.77
Mirtazapine 416 Other antidepressant drugs 1,074 0.39 0.57 0.10 -1.71
Clotrimazole 38 Vaginal and vulval infections 50 0.76 0.90 0.09 -1.67
Prednisolone 5 Copound haemorrhoidal preparations with corticosteroid 92 0.05 0.43 0.24 -1.57