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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Isotretinoin 1 Oral preparations for acne 1 1.00 0.02 0.13 7.77
Sucroferric oxyhydroxide 9 Phosphate binding agents 29 0.31 0.00 0.05 6.68
Doxycycline hyclate 3 Drugs for oral ulceration and inflammation 29 0.10 0.00 0.02 6.19
Cefixime 1 Cephalosporins 21 0.05 0.00 0.01 4.85
Ketotifen fumarate 13 Other anti-inflammatory preparations 64 0.20 0.02 0.04 4.65
Duloxetine hydrochloride 161 Drugs for urinary frequency enuresis and incontinence 814 0.20 0.04 0.04 4.13
Fluticasone propionate (Nasal) 366 Drugs used in nasal allergy 861 0.43 0.13 0.07 4.00
Umeclidinium bromide 168 Antimuscarinic bronchodilators 305 0.55 0.12 0.13 3.38
Hamamalis 2 Other anti-inflammatory preparations 64 0.03 0.00 0.01 3.08
Combined ethinylestradiol 20mcg 93 Combined hormonal contraceptives 295 0.32 0.12 0.06 2.96

Prescribing where Whiteacres Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-cyprindiol (Cyprote acetate/ethinylestradiol) 0 Oral preparations for acne 1 0.00 0.98 0.13 -7.77
    Benzydamine hydrochloride 13 Drugs for oral ulceration and inflammation 29 0.45 0.84 0.16 -2.47
    Combined ethinylestradiol 30mcg 187 Combined hormonal contraceptives 295 0.63 0.81 0.07 -2.45
    Tacrolimus 5 Drugs affecting the immune response 13 0.38 0.81 0.19 -2.17
    Amoxicillin 822 Broad-spectrum penicillins 1,157 0.71 0.85 0.07 -2.11
    Permethrin 1 Parasiticidal preparations 3 0.33 0.83 0.24 -2.07
    Clobetasone butyrate 43 Topical corticosteroids 1,296 0.03 0.13 0.05 -2.03
    Ferrous fumarate 126 Oral iron 926 0.14 0.57 0.23 -1.86
    Memantine hydrochloride 16 Drugs for dementia 251 0.06 0.38 0.18 -1.77
    Acamprosate calcium 2 Alcohol dependence 7 0.29 0.83 0.31 -1.76