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Prototype Prescribing Outlier Dashboard for Oak Tree 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 Oak Tree Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nadolol 20 Beta-adrenoceptor blocking drugs 1,808 0.01 0.00 0.00 11.32
Paraldehyde 2 Drugs used in status epilepticus 3 0.67 0.01 0.08 7.97
Ketone blood testing reagents 142 Diabetic diagnostic and monitoring agents 640 0.22 0.05 0.03 5.84
Low protein biscuits 17 Foods for special diets 193 0.09 0.00 0.02 5.43
Amiloride hydrochloride 66 Potassium-sparing diuretics and aldosterone antagonists 271 0.24 0.03 0.04 5.29
Levonorgestrel 65 Oral progestogen-only contraceptives 762 0.09 0.01 0.02 4.29
Ciprofloxacin 19 Antibacterials 62 0.31 0.05 0.06 4.15
Glycopyrronium/formoterol 5 Compound bronchodilator preparations 110 0.05 0.00 0.01 3.99
Flavoxate hydrochloride 8 Drugs for urinary frequency enuresis and incontinence 345 0.02 0.00 0.01 3.91
Diltiazem hydrochloride 1 Soothing haemorrhoidal preparations 1 1.00 0.15 0.22 3.91

Prescribing where Oak Tree Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glucose blood testing reagents 497 Diabetic diagnostic and monitoring agents 640 0.78 0.94 0.03 -4.89
Hydralazine hydrochloride 0 Vasodilator antihypertensive drugs 2 0.00 0.85 0.28 -3.04
    Zinc oxide 0 Soothing haemorrhoidal preparations 1 0.00 0.77 0.26 -3.01
      Acamprosate calcium 0 Alcohol dependence 10 0.00 0.83 0.31 -2.69
        Mirtazapine 423 Other antidepressant drugs 1,358 0.31 0.57 0.10 -2.44
        Oral rehydration salts 0 Oral sodium and water 7 0.00 0.71 0.29 -2.42
          Desogestrel 623 Oral progestogen-only contraceptives 762 0.82 0.93 0.05 -2.16
          Isosorbide mononitrate 79 Nitrates 158 0.50 0.72 0.11 -2.06
          Solifenacin 38 Drugs for urinary frequency enuresis and incontinence 345 0.11 0.33 0.11 -1.95
          Calcipotriol 81 Preparations for psoriasis 113 0.72 0.87 0.08 -1.92