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Prototype Prescribing Outlier Dashboard for Mid Devon 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 Mid Devon Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dipipanone hydrochloride 7 Opioid analgesics 1,593 0.00 0.00 0.00 9.47
Fluorescein sodium 1 Ocular diagnostic & peri-operative prepn & photodynamic tt 3 0.33 0.00 0.04 9.04
Telmisartan 235 Angiotensin-II receptor antagonists 1,578 0.15 0.01 0.02 6.08
Tioconazole 18 Antifungal preparations 130 0.14 0.01 0.02 5.68
Lercanidipine hydrochloride 1,892 Calcium-channel blockers 4,068 0.47 0.06 0.07 5.59
Other vitamin A preparations 0906011 4 Vitamin A 4 1.00 0.04 0.18 5.47
Calcium acetate/magnesium carbonate 2 Phosphate binding agents 2 1.00 0.05 0.18 5.35
Isophane insulin 219 Intermediate and long-acting insulins 329 0.67 0.12 0.10 5.35
Propiverine hydrochloride 28 Drugs for urinary frequency enuresis and incontinence 576 0.05 0.00 0.01 5.27
Mizolastine 23 Antihistamines 920 0.02 0.00 0.00 4.91

Prescribing where Mid Devon Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amlodipine 1,544 Calcium-channel blockers 4,068 0.38 0.76 0.11 -3.34
Neomycin sulfate 5 Nasal preparations for infection 11 0.45 0.84 0.14 -2.79
Baclofen 30 Skeletal muscle relaxants 79 0.38 0.83 0.18 -2.47
Amoxicillin 180 Broad-spectrum penicillins 260 0.69 0.85 0.07 -2.38
Lactulose 28 Osmotic laxatives 487 0.06 0.28 0.10 -2.31
Vitamin A 0 Vitamin A 4 0.00 0.82 0.36 -2.28
    Alendronic acid 556 Bisphosphonates and other drugs 838 0.66 0.87 0.09 -2.26
    Codeine phosphate 0 Cough suppressants 4 0.00 0.74 0.33 -2.22
      Apixaban 209 Oral anticoagulants 1,921 0.11 0.41 0.14 -2.12
      Permethrin 1 Parasiticidal preparations 3 0.33 0.83 0.24 -2.07