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Prototype Prescribing Outlier Dashboard for Lander Medical 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 Lander Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other urological pain preparations 1 Drugs used in urological pain 1 1.00 0.00 0.06 15.77
Prazosin hydrochloride 73 Alpha-adrenoceptor blocking drugs 466 0.16 0.00 0.01 12.55
Trimetazidine hydrochloride 7 Calcium-channel blockers 4,929 0.00 0.00 0.00 9.90
Phenol 4 Preparations for minor cuts and abrasions 5 0.80 0.01 0.09 8.45
Quinapril hydrochloride with diuretic 4 Angiotensin-converting enzyme inhibitors 5,654 0.00 0.00 0.00 8.04
Hydromorphone hydrochloride 14 Opioid analgesics 2,944 0.00 0.00 0.00 3.83
Tafluprost and timolol 70 Treatment of glaucoma 2,162 0.03 0.00 0.01 3.72
Quinagolide hydrochloride 6 Bromocriptine and other dopaminergic drugs 10 0.60 0.04 0.16 3.60
Dantrolene sodium 97 Skeletal muscle relaxants 481 0.20 0.02 0.05 3.51
Pioglitazone hydrochloride 354 Other antidiabetic drugs 1,721 0.21 0.04 0.05 3.26

Prescribing where Lander Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Doxazosin mesilate 388 Alpha-adrenoceptor blocking drugs 466 0.83 0.99 0.02 -8.20
Potassium citrate 0 Drugs used in urological pain 1 0.00 0.92 0.25 -3.67
    Glucosamine hydrochloride (Rheumatic) 0 Other drugs for rheumatic diseases 1 0.00 0.88 0.33 -2.66
      Glycopyrronium bromide 2 Antimuscarinic drugs 23 0.09 0.82 0.35 -2.09
      Cabergoline 3 Bromocriptine and other dopaminergic drugs 10 0.30 0.86 0.27 -2.06
      Levothyroxine sodium 4,041 Thyroid hormones 4,070 0.99 1.00 0.00 -1.93
      Methylprednisolone acetate 8 Local corticosteroid injections 174 0.05 0.74 0.39 -1.77
      Lansoprazole 1,806 Proton pump inhibitors 10,599 0.17 0.44 0.16 -1.71
      Ferrous fumarate 167 Oral iron 859 0.19 0.57 0.23 -1.61
      Ramipril 2,467 Angiotensin-converting enzyme inhibitors 5,654 0.44 0.69 0.17 -1.55