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Prototype Prescribing Outlier Dashboard for Bideford Medical 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 Bideford Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Heparin sodium 7 Parenteral anticoagulants 34 0.21 0.00 0.01 26.60
Flumetasone pivalate 11 Otitis externa 260 0.04 0.00 0.01 5.34
Diltiazem hydrochloride 782 Calcium-channel blockers 4,368 0.18 0.05 0.03 4.92
Nebivolol 436 Beta-adrenoceptor blocking drugs 5,246 0.08 0.02 0.02 3.90
Ferrous gluconate 140 Oral iron 615 0.23 0.03 0.05 3.71
Indacaterol/glycopyrronium 228 Compound bronchodilator preparations 306 0.75 0.15 0.20 3.00
Docusate sodium 990 Stimulant laxatives 1,577 0.63 0.25 0.14 2.78
Tolterodine 325 Drugs for urinary frequency enuresis and incontinence 888 0.37 0.14 0.09 2.69
Cetrimide 1 Preparations for minor cuts and abrasions 1 1.00 0.17 0.34 2.41
Flunarizine dihydrochloride 4 Drugs used in nausea and vertigo 1,038 0.00 0.00 0.00 2.39

Prescribing where Bideford Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Senna 310 Stimulant laxatives 1,577 0.20 0.55 0.14 -2.56
Glycopyrronium bromide 0 Antimuscarinic drugs 47 0.00 0.82 0.35 -2.34
    Fexofenadine hydrochloride 275 Antihistamines 2,105 0.13 0.34 0.12 -1.81
    Oral rehydration salts 14 Oral sodium and water 64 0.22 0.71 0.29 -1.67
    Lactulose 147 Osmotic laxatives 1,223 0.12 0.28 0.10 -1.66
    Tacrolimus 0 Corticosteroids and other immunosuppressants 1 0.00 0.63 0.40 -1.58
      Pravastatin sodium 34 Lipid-regulating drugs 8,529 0.00 0.03 0.02 -1.48
      Fusidic acid 57 Antibacterial preparations also used systemically 105 0.54 0.75 0.14 -1.44
      Ivermectin 4 Topical preparation for rosacea 7 0.57 0.88 0.22 -1.39
      Biphasic insulin aspart 14 Intermediate and long-acting insulins 653 0.02 0.14 0.09 -1.37