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Prototype Prescribing Outlier Dashboard for Dr Sinha & Tahir

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 Dr Sinha & Tahir is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Propamidine isetionate 2 Antibacterials 54 0.04 0.00 0.00 9.76
Dicycloverine hydrochloride 36 Antispasmodic and other drugs altering gut motility 421 0.09 0.01 0.01 6.11
Olmesartan medoxomil/amlodipine 20 Angiotensin-II receptor antagonists 1,370 0.01 0.00 0.00 4.64
Captopril 43 Angiotensin-converting enzyme inhibitors 3,552 0.01 0.00 0.00 4.58
Bromfenac 16 Ocular diagnostic & peri-operative prepn & photodynamic tt 16 1.00 0.09 0.21 4.25
Perampanel 47 Control of epilepsy 2,705 0.02 0.00 0.00 4.22
Griseofulvin 2 Other antifungals 15 0.13 0.01 0.03 4.02
Analgesics with anti-emetics 54 Treatment of acute migraine 227 0.24 0.04 0.05 4.00
Trimipramine maleate 16 Tricyclic and related antidepressant drugs 939 0.02 0.00 0.00 3.85
Oestrogens conjugated with progestogen 7 Oestrogens and Hormone Replacement Therapy 79 0.09 0.01 0.02 3.82

Prescribing where Dr Sinha & Tahir is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Terbinafine hydrochloride 13 Other antifungals 15 0.87 0.99 0.03 -4.02
Permethrin 8 Parasiticidal preparations 46 0.17 0.83 0.24 -2.73
Estradiol 2 Preparations for vaginal/vulval changes 27 0.07 0.55 0.20 -2.30
Betamethasone valerate 106 Topical corticosteroids 713 0.15 0.28 0.07 -2.00
Zinc sulfate monohydrate 0 Zinc 7 0.00 0.74 0.39 -1.90
    Progesterone 1 Progestogens and progesterone receptor modulators 38 0.03 0.53 0.27 -1.86
    Prucalopride 6 Other drugs used in constipation 40 0.15 0.71 0.32 -1.73
    Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 6 0.00 0.67 0.39 -1.73
      Alendronic acid 280 Bisphosphonates and other drugs 390 0.72 0.87 0.09 -1.67
      Gliclazide 421 Sulfonylureas 585 0.72 0.93 0.13 -1.54