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Prototype Prescribing Outlier Dashboard for Wychall Lane 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 Wychall Lane Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Trientine dihydrochloride 7 Drugs used in metabolic disorders 7 1.00 0.02 0.13 7.85
Modafinil 3 CNS Stimulants and drugs used for ADHD 3 1.00 0.06 0.12 7.76
Paraffin soft white 24 Emollients 831 0.03 0.00 0.01 5.38
Other oral iron preparations 16 Oral iron 473 0.03 0.00 0.01 5.13
Rutosides 4 Peripheral vasodilators and related drugs 4 1.00 0.06 0.19 4.97
Oxycodone hydrochloride/naloxone hydrochloride 46 Opioid analgesics 1,971 0.02 0.00 0.00 4.55
Bambuterol hydrochloride 6 Selective beta(2)-agonists 2,338 0.00 0.00 0.00 3.94
Indoramin 16 Drugs for urinary retention 464 0.03 0.00 0.01 3.67
Penicillamine 6 Rheumatic disease suppressant drugs 197 0.03 0.00 0.01 3.21
Tetracycline 12 Tetracyclines 332 0.04 0.01 0.01 3.04

Prescribing where Wychall Lane Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Methylphenidate hydrochloride 0 CNS Stimulants and drugs used for ADHD 3 0.00 0.65 0.20 -3.18
    Estradiol with progestogen 43 Oestrogens and Hormone Replacement Therapy 375 0.11 0.39 0.12 -2.33
    Timolol and bimatoprost 0 Treatment of glaucoma 796 0.00 0.10 0.05 -1.93
      Allopurinol 424 Gout and cytotoxic induced hyperiuicaemia 531 0.80 0.90 0.05 -1.90
      Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 4 0.00 0.67 0.39 -1.73
        Ivermectin 1 Topical preparation for rosacea 2 0.50 0.88 0.22 -1.70
        Memantine hydrochloride 3 Drugs for dementia 32 0.09 0.38 0.18 -1.60
        Warfarin sodium 80 Oral anticoagulants 1,244 0.06 0.24 0.11 -1.59
        Urea hydrogen peroxide 1 Removal of ear wax and other substances 3 0.33 0.83 0.33 -1.51
        Bimatoprost 17 Treatment of glaucoma 796 0.02 0.11 0.06 -1.51