Skip to main content

Prototype Prescribing Outlier Dashboard for All Saints Surgery

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 All Saints Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorpromazine hydrochloride 15 Antipsychotic drugs 22 0.68 0.02 0.03 22.73
Sodium fusidate 4 Some other antibacterials 4 1.00 0.01 0.06 15.30
Low protein miscellaneous 5 Foods for special diets 224 0.02 0.00 0.00 12.15
Tetracaine 33 Local anaesthetics 49 0.67 0.02 0.06 10.35
Raloxifene hydrochloride 16 Oestrogens and Hormone Replacement Therapy 59 0.27 0.01 0.03 10.13
Telmisartan 230 Angiotensin-II receptor antagonists 1,040 0.22 0.01 0.02 9.34
Torasemide 19 Loop diuretics 417 0.05 0.00 0.00 9.30
Rivastigmine 2 Drugs for dementia 2 1.00 0.10 0.10 8.99
Haloperidol 6 Antipsychotic drugs 22 0.27 0.03 0.03 8.34
Hepatitis B 9 Vaccines and antisera 11 0.82 0.02 0.11 6.93

Prescribing where All Saints Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lidocaine hydrochloride 16 Local anaesthetics 49 0.33 0.90 0.13 -4.29
Methotrexate 0 Rheumatic disease suppressant drugs 104 0.00 0.58 0.15 -3.73
    Influenza 0 Vaccines and antisera 11 0.00 0.88 0.28 -3.13
      Quetiapine 0 Antipsychotic drugs 22 0.00 0.35 0.12 -2.87
        Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
          Senna 12 Stimulant laxatives 72 0.17 0.55 0.14 -2.77
          Donepezil hydrochloride 0 Drugs for dementia 2 0.00 0.49 0.18 -2.66
            Glucose blood testing reagents 898 Diabetic diagnostic and monitoring agents 1,049 0.86 0.94 0.03 -2.55
            Olanzapine 0 Antipsychotic drugs 22 0.00 0.22 0.09 -2.50
              Amlodipine 1,273 Calcium-channel blockers 2,625 0.48 0.76 0.11 -2.40