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Prototype Prescribing Outlier Dashboard for Church Street Surgery, Martock

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 Church Street Surgery, Martock is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pimozide 9 Antipsychotic drugs 1,022 0.01 0.00 0.00 4.69
Magnesium sulfate 1 Magnesium 12 0.08 0.00 0.02 4.32
Bromfenac 10 Ocular diagnostic & peri-operative prepn & photodynamic tt 10 1.00 0.09 0.21 4.25
Estradiol and estriol with progestogen 13 Oestrogens and Hormone Replacement Therapy 573 0.02 0.00 0.01 3.85
Fosinopril sodium 8 Angiotensin-converting enzyme inhibitors 4,883 0.00 0.00 0.00 3.61
Topiramate 312 Control of epilepsy 3,060 0.10 0.04 0.02 3.55
Ferric maltol 13 Oral iron 983 0.01 0.00 0.00 3.43
Silver nitrate 7 Preparations for warts and calluses 12 0.58 0.07 0.16 3.11
Midazolam maleate 1 Drugs used in status epilepticus 1 1.00 0.18 0.28 2.96
Aripiprazole 321 Antipsychotic drugs 1,022 0.31 0.13 0.06 2.89

Prescribing where Church Street Surgery, Martock is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
    Nitrofurantoin 491 Urinary-tract infections 608 0.81 0.96 0.06 -2.65
    Mercaptopurine 0 Antimetabolites 5 0.00 0.80 0.35 -2.32
      Methylprednisolone acetate 2 Local corticosteroid injections 42 0.05 0.74 0.39 -1.77
      Salicylic acid 2 Preparations for warts and calluses 12 0.17 0.67 0.31 -1.63
      Dexamethasone 104 Otitis externa 176 0.59 0.78 0.12 -1.55
      Atropine sulfate 1 Mydriatics and cycloplegics 6 0.17 0.72 0.37 -1.48
      Combined ethinylestradiol 20mcg 13 Combined hormonal contraceptives 379 0.03 0.12 0.06 -1.39
      Magnesium aspartate 0 Magnesium 12 0.00 0.55 0.40 -1.38
        Hydroxychloroquine sulfate 69 Rheumatic disease suppressant drugs 444 0.16 0.37 0.16 -1.38