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Prototype Prescribing Outlier Dashboard for Beckington Family 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 Beckington Family Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenazone/lidocaine 11 Otitis externa 172 0.06 0.00 0.00 63.67
Heparinoid 266 Rubefacients, topical NSAIDS, capsaicin and poultice 821 0.32 0.03 0.04 7.05
Ofloxacin 21 Antibacterials 125 0.17 0.01 0.03 5.40
Fluvastatin sodium 126 Lipid-regulating drugs 11,269 0.01 0.00 0.00 5.09
Olmesartan medoxomil/amlodipine 43 Angiotensin-II receptor antagonists 2,766 0.02 0.00 0.00 4.96
Dantrolene sodium 12 Skeletal muscle relaxants 51 0.24 0.02 0.05 4.16
Amiloride hydrochloride 152 Potassium-sparing diuretics and aldosterone antagonists 839 0.18 0.03 0.04 3.73
Telmisartan 267 Angiotensin-II receptor antagonists 2,766 0.10 0.01 0.02 3.71
Isosorbide dinitrate 68 Nitrates 701 0.10 0.01 0.03 3.33
Zuclopenthixol hydrochloride 42 Antipsychotic drugs 814 0.05 0.01 0.01 3.15

Prescribing where Beckington Family Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glycopyrronium bromide 0 Antimuscarinic drugs 1 0.00 0.82 0.35 -2.34
    Tacrolimus 5 Drugs affecting the immune response 13 0.38 0.81 0.19 -2.17
    Fusidic acid 48 Antibacterial preparations also used systemically 108 0.44 0.75 0.14 -2.14
    Ramipril 2,416 Angiotensin-converting enzyme inhibitors 6,190 0.39 0.69 0.17 -1.83
    Nitrofurantoin 379 Urinary-tract infections 441 0.86 0.96 0.06 -1.78
    Amlodipine 4,109 Calcium-channel blockers 7,179 0.57 0.76 0.11 -1.63
    Mupirocin 1 Antibacterial preparations only used topically 11 0.09 0.64 0.36 -1.54
    Medroxyprogesterone acetate 39 Parenteral progestogen-only contraceptives 60 0.65 0.88 0.15 -1.52
    Procyclidine hydrochloride 37 Antimuscarinic drugs used in parkinsonism 68 0.54 0.85 0.21 -1.46
    Medroxyprogesterone acetate 0 Progestogens 1 0.00 0.66 0.45 -1.46