Skip to main content

Prototype Prescribing Outlier Dashboard for The Wellspring 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 The Wellspring Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hamamalis 11 Other anti-inflammatory preparations 126 0.09 0.00 0.01 8.89
Sodium bicarbonate 3 Electrolytes and water 11 0.27 0.00 0.03 8.11
Ciprofloxain/dexameth 56 Otitis externa 127 0.44 0.05 0.06 6.00
Magnesium oxide 4 Antacids and simeticone 4 1.00 0.05 0.18 5.23
Duloxetine hydrochloride 68 Drugs for urinary frequency enuresis and incontinence 348 0.20 0.04 0.04 4.07
Levetiracetam 397 Control of epilepsy 1,637 0.24 0.09 0.04 3.85
Moxifloxacin 4 Quinolones 35 0.11 0.01 0.03 3.67
Fondaparinux sodium 1 Parenteral anticoagulants 9 0.11 0.00 0.03 3.40
Dexpanthenol 4 Emollients 171 0.02 0.00 0.01 3.38
Budesonide 30 Drugs used in nasal allergy 464 0.06 0.01 0.02 3.00

Prescribing where The Wellspring Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dexamethasone 61 Otitis externa 127 0.48 0.78 0.12 -2.43
Isosorbide mononitrate 71 Nitrates 154 0.46 0.72 0.11 -2.42
Glycopyrronium bromide 0 Antimuscarinic drugs 1 0.00 0.82 0.35 -2.34
    Betahistine hydrochloride 5 Drugs used in nausea and vertigo 249 0.02 0.27 0.11 -2.28
    Alfentanil hydrochloride 0 Opioid analgesics 2 0.00 0.82 0.38 -2.18
      Carbimazole 27 Antithyroid drugs 38 0.71 0.93 0.10 -2.14
      Hydrocortisone 13 Copound haemorrhoidal preparations with corticosteroid 110 0.12 0.57 0.24 -1.86
      Alendronic acid 205 Bisphosphonates and other drugs 288 0.71 0.87 0.09 -1.74
      Allopurinol 186 Gout and cytotoxic induced hyperiuicaemia 230 0.81 0.90 0.05 -1.71
      Ciprofloxacin 22 Quinolones 35 0.63 0.86 0.14 -1.69