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Prototype Prescribing Outlier Dashboard for The Castle 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 The Castle Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Indoramin 7 Alpha-adrenoceptor blocking drugs 638 0.01 0.00 0.00 662.35
Vancomycin hydrochloride 3 Some other antibacterials 3 1.00 0.05 0.13 7.11
Ethosuximide 43 Control of epilepsy 3,045 0.01 0.00 0.00 5.32
Heparin flushes 2 Parenteral anticoagulants 3 0.67 0.04 0.12 5.05
Glycopyrronium bromide 326 Antimuscarinic bronchodilators 621 0.52 0.06 0.10 4.70
Isocarboxazid 7 Monoamine-oxidase inhibitors (maois) 7 1.00 0.08 0.27 3.43
Famciclovir 6 Herpes simplex and varicella-zoster 85 0.07 0.01 0.02 3.30
Metoclopramide hydrochloride 174 Drugs used in nausea and vertigo 589 0.30 0.11 0.06 2.86
Apomorphine hydrochloride 8 Dopaminergic drugs used in parkinsonism 307 0.03 0.00 0.01 2.85
Donepezil hydrochloride 7 Drugs for dementia 7 1.00 0.49 0.18 2.78

Prescribing where The Castle Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ciprofloxacin 11 Quinolones 20 0.55 0.86 0.14 -2.26
Warfarin sodium 9 Oral anticoagulants 1,721 0.01 0.24 0.11 -2.14
Memantine hydrochloride 0 Drugs for dementia 7 0.00 0.38 0.18 -2.13
    Quinine sulfate 180 Antimalarials 285 0.63 0.90 0.14 -1.95
    Zinc sulfate monohydrate 0 Zinc 3 0.00 0.74 0.39 -1.90
      Vitamin E 0 Vitamin E 6 0.00 0.72 0.41 -1.76
        Tacrolimus 0 Corticosteroids and other immunosuppressants 14 0.00 0.63 0.40 -1.58
          Mesalazine (Systemic) 83 Aminosalicylates 198 0.42 0.65 0.15 -1.58
          Lactulose 115 Osmotic laxatives 864 0.13 0.28 0.10 -1.52
          Tiotropium bromide 272 Antimuscarinic bronchodilators 621 0.44 0.71 0.18 -1.51