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Prototype Prescribing Outlier Dashboard for Bicester Health Centre

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 Bicester Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Eprosartan 450 Angiotensin-II receptor antagonists 3,783 0.12 0.00 0.01 21.44
Co-danthrusate (Dantron/docusate sodium) 3 Stimulant laxatives 783 0.00 0.00 0.00 10.89
Flutamide 7 Prostate cancer and gonadorelin analogues 232 0.03 0.00 0.00 8.13
Cabergoline 32 Dopaminergic drugs used in parkinsonism 570 0.06 0.00 0.01 7.21
Dipipanone hydrochloride 9 Opioid analgesics 2,785 0.00 0.00 0.00 6.94
Glycopyrronium/formoterol 19 Compound bronchodilator preparations 278 0.07 0.00 0.01 6.09
Dronabinol/cannabidiol 6 Skeletal muscle relaxants 122 0.05 0.00 0.01 5.19
Hydromorphone hydrochloride 17 Opioid analgesics 2,785 0.01 0.00 0.00 4.96
Nadolol 19 Beta-adrenoceptor blocking drugs 4,591 0.00 0.00 0.00 4.00
Calcitriol 25 Preparations for psoriasis 229 0.11 0.01 0.02 3.99

Prescribing where Bicester Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydralazine hydrochloride 0 Vasodilator antihypertensive drugs 2 0.00 0.85 0.28 -3.04
    Acamprosate calcium 0 Alcohol dependence 9 0.00 0.83 0.31 -2.69
      Solifenacin 37 Drugs for urinary frequency enuresis and incontinence 1,123 0.03 0.33 0.11 -2.63
      Doxazosin mesilate 705 Alpha-adrenoceptor blocking drugs 749 0.94 0.99 0.02 -2.56
      Amitriptyline hydrochloride 2,109 Tricyclic and related antidepressant drugs 3,187 0.66 0.84 0.08 -2.37
      Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 5 0.00 0.67 0.39 -1.73
        Medroxyprogesterone acetate 63 Parenteral progestogen-only contraceptives 102 0.62 0.88 0.15 -1.73
        Carbimazole 92 Antithyroid drugs 122 0.75 0.93 0.10 -1.72
        Calcipotriol 168 Preparations for psoriasis 229 0.73 0.87 0.08 -1.72
        Pizotifen malate 3 Prophylaxis of migraine 14 0.21 0.63 0.26 -1.62