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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenylbutazone 3 Non-steroidal anti-inflammatory drugs 1,642 0.00 0.00 0.00 24.90
Levomepromazine hydrochloride 70 Antipsychotic drugs 802 0.09 0.01 0.02 4.86
Other eye tear/lubricant/astringent preparations 68 Tear deficiency, eye lubricant/astringent 678 0.10 0.01 0.02 4.36
Other magnesium preparations 3 Magnesium 10 0.30 0.01 0.07 4.33
Isophane insulin 458 Intermediate and long-acting insulins 829 0.55 0.12 0.10 4.23
Mexiletine hydrochloride 5 Drugs for arrhythmias 129 0.04 0.00 0.01 3.77
Calcium gluconate 4 Calcium supplements 38 0.11 0.00 0.03 3.67
Tafluprost and timolol 60 Treatment of glaucoma 1,961 0.03 0.00 0.01 3.49
Indoramin 48 Drugs for urinary retention 1,511 0.03 0.00 0.01 3.35
Darifenacin hydrobromide 149 Drugs for urinary frequency enuresis and incontinence 1,232 0.12 0.01 0.03 3.11

Prescribing where Coleridge Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ciprofloxacin 31 Quinolones 58 0.53 0.86 0.14 -2.38
Co-codamol (Codeine phosphate/paracetamol) 383 Non-opioid analgesics and compound preparations 4,106 0.09 0.45 0.15 -2.33
Glycopyrronium bromide 1 Antimuscarinic drugs 38 0.03 0.82 0.35 -2.26
Procyclidine hydrochloride 12 Antimuscarinic drugs used in parkinsonism 30 0.40 0.85 0.21 -2.16
Lactulose 113 Osmotic laxatives 1,555 0.07 0.28 0.10 -2.16
Clotrimazole 60 Vaginal and vulval infections 82 0.73 0.90 0.09 -1.99
Oral rehydration salts 9 Oral sodium and water 45 0.20 0.71 0.29 -1.74
Losartan potassium 675 Angiotensin-II receptor antagonists 3,636 0.19 0.50 0.19 -1.70
Senna 558 Stimulant laxatives 1,682 0.33 0.55 0.14 -1.59
Dexamethasone 141 Otitis externa 240 0.59 0.78 0.12 -1.58