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Prototype Prescribing Outlier Dashboard for Westbury Group 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 Westbury Group Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Betamethasone sodium phosphate 152 Otitis externa 384 0.40 0.03 0.06 6.32
Oils for the ear 1 Removal of ear wax and other substances 2 0.50 0.01 0.10 4.81
Cefadroxil 7 Cephalosporins 199 0.04 0.00 0.01 4.11
Acetic acid 86 Otitis externa 384 0.22 0.04 0.05 3.41
Mometasone furoate 10 Corticosteroids (respiratory) 4,904 0.00 0.00 0.00 3.05
Levonorgestrel 58 Oral progestogen-only contraceptives 925 0.06 0.01 0.02 2.96
Ephedrine hydrochloride 7 Topical nasal decongestants 54 0.13 0.01 0.04 2.85
Etonogestrel 66 Parenteral progestogen-only contraceptives 120 0.55 0.12 0.15 2.81
Pentoxifylline 6 Peripheral vasodilators and related drugs 7 0.86 0.15 0.30 2.39
Quinine bisulfate 185 Antimalarials 442 0.42 0.10 0.13 2.35

Prescribing where Westbury Group Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dexamethasone 130 Otitis externa 384 0.34 0.78 0.12 -3.57
Medroxyprogesterone acetate 54 Parenteral progestogen-only contraceptives 120 0.45 0.88 0.15 -2.81
Quinine sulfate 257 Antimalarials 442 0.58 0.90 0.14 -2.32
Ivermectin 14 Topical preparation for rosacea 30 0.47 0.88 0.22 -1.85
Memantine hydrochloride 80 Drugs for dementia 1,011 0.08 0.38 0.18 -1.69
Cabergoline 5 Bromocriptine and other dopaminergic drugs 11 0.45 0.86 0.27 -1.49
Medroxyprogesterone acetate 0 Progestogens 1 0.00 0.66 0.45 -1.46
    Midazolam hydrochloride 4 Drugs used in status epilepticus 10 0.40 0.80 0.28 -1.41
    Naftidrofuryl oxalate 1 Peripheral vasodilators and related drugs 7 0.14 0.67 0.39 -1.36
    Mometasone furoate 213 Drugs used in nasal allergy 1,419 0.15 0.32 0.13 -1.28