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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Iron and folic acid 38 Oral iron 440 0.09 0.00 0.01 13.80
Benzbromarone 3 Gout and cytotoxic induced hyperiuicaemia 992 0.00 0.00 0.00 8.50
Dequalinium chloride 1 Vaginal and vulval infections 23 0.04 0.00 0.01 8.30
Azelastine hydrochloride 104 Other anti-inflammatory preparations 196 0.53 0.06 0.08 6.24
Metoclopramide hydrochloride 206 Drugs used in nausea and vertigo 499 0.41 0.11 0.06 4.68
Escitalopram 800 Selective serotonin re-uptake inhibitors 5,050 0.16 0.04 0.04 3.45
Omega-3-acid ethyl esters 65 Lipid-regulating drugs 8,589 0.01 0.00 0.00 3.05
Benzalkonium chloride 7 Barrier preparations 15 0.47 0.05 0.14 2.96
Estradiol and nomegestrol 5 Combined hormonal contraceptives 509 0.01 0.00 0.00 2.92
Betaxolol 16 Treatment of glaucoma 1,137 0.01 0.00 0.00 2.90

Prescribing where Ramsbury Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium cromoglicate 36 Other anti-inflammatory preparations 196 0.18 0.64 0.19 -2.42
Midazolam hydrochloride 2 Drugs used in status epilepticus 13 0.15 0.80 0.28 -2.28
Folic acid 732 Drugs used in megaloblastic anaemias 1,984 0.37 0.69 0.16 -2.06
Other food for special diet preparations 21 Foods for special diets 125 0.17 0.65 0.24 -1.99
Urea hydrogen peroxide 2 Removal of ear wax and other substances 11 0.18 0.83 0.33 -1.97
Carbimazole 47 Antithyroid drugs 64 0.73 0.93 0.10 -1.91
Miconazole nitrate 7 Antifungal preparations 143 0.05 0.27 0.13 -1.71
Letrozole 24 Breast cancer 302 0.08 0.45 0.22 -1.70
Sodium chloride 2 Topical nasal decongestants 35 0.06 0.54 0.30 -1.61
Oxybutynin 41 Drugs for urinary frequency enuresis and incontinence 1,145 0.04 0.18 0.09 -1.60