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Prototype Prescribing Outlier Dashboard for Penketh Health 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 Penketh Health Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ichthammol 2 Preparations for eczema 2 1.00 0.02 0.15 6.52
Bupivacaine hydrochloride 41 Local anaesthetics 192 0.21 0.01 0.05 4.45
Phenobarbital 109 Control of epilepsy 3,882 0.03 0.01 0.01 3.64
Latanoprost and timolol 163 Treatment of glaucoma 1,218 0.13 0.04 0.03 3.42
Linagliptin 827 Other antidiabetic drugs 1,643 0.50 0.16 0.10 3.31
Cyclizine lactate 54 Drugs used in nausea and vertigo 830 0.07 0.01 0.02 3.21
Atomoxetine hydrochloride 6 CNS Stimulants and drugs used for ADHD 14 0.43 0.08 0.11 3.21
Terazosin hydrochloride 44 Alpha-adrenoceptor blocking drugs 917 0.05 0.01 0.01 3.13
Imiquimod 9 Preparations for warts and calluses 9 1.00 0.19 0.26 3.11
Ketone blood testing reagents 118 Diabetic diagnostic and monitoring agents 847 0.14 0.05 0.03 3.08

Prescribing where Penketh Health Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gamolenic acid 0 Preparations for eczema 2 0.00 0.90 0.30 -3.04
    Acamprosate calcium 0 Alcohol dependence 7 0.00 0.83 0.31 -2.69
      Glucose blood testing reagents 729 Diabetic diagnostic and monitoring agents 847 0.86 0.94 0.03 -2.41
      Salicylic acid 0 Preparations for warts and calluses 9 0.00 0.67 0.31 -2.17
        Doxazosin mesilate 871 Alpha-adrenoceptor blocking drugs 917 0.95 0.99 0.02 -2.12
        Amitriptyline hydrochloride 1,074 Tricyclic and related antidepressant drugs 1,557 0.69 0.84 0.08 -2.00
        Methylprednisolone acetate 1 Local corticosteroid injections 72 0.01 0.74 0.39 -1.85
        Lidocaine hydrochloride 130 Local anaesthetics 192 0.68 0.90 0.13 -1.69
        Diazepam 300 Anxiolytics 560 0.54 0.75 0.13 -1.64
        Tamsulosin hydrochloride 1,088 Drugs for urinary retention 1,323 0.82 0.92 0.06 -1.63