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Prototype Prescribing Outlier Dashboard for The Elms Medical 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 The Elms Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Avanafil 18 Drugs for erectile dysfunction 447 0.04 0.00 0.01 5.48
Triptorelin embonate 10 Prostate cancer and gonadorelin analogues 26 0.38 0.03 0.07 5.17
Ciprofloxacin 32 Otitis externa 279 0.11 0.02 0.03 3.77
Sodium zirconium cyclosilicate 3 Oral potassium 8 0.38 0.02 0.10 3.75
Dihydrocodeine tartrate 612 Opioid analgesics 2,823 0.22 0.06 0.05 2.95
Ketone blood testing reagents 90 Diabetic diagnostic and monitoring agents 704 0.13 0.05 0.03 2.69
Prazosin hydrochloride 30 Alpha-adrenoceptor blocking drugs 818 0.04 0.00 0.01 2.69
Acetic acid 50 Otitis externa 279 0.18 0.04 0.05 2.58
Alverine citrate 84 Antispasmodic and other drugs altering gut motility 529 0.16 0.04 0.05 2.27
Clindamycin phosphate 29 Topical preparations for acne 157 0.18 0.06 0.06 2.19

Prescribing where The Elms Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Doxazosin mesilate 771 Alpha-adrenoceptor blocking drugs 818 0.94 0.99 0.02 -2.49
Potassium chloride 5 Oral potassium 8 0.62 0.96 0.14 -2.43
Glucose blood testing reagents 612 Diabetic diagnostic and monitoring agents 704 0.87 0.94 0.03 -2.15
Water for injection 1 Electrolytes and water 3 0.33 0.82 0.25 -1.98
Methylprednisolone acetate 11 Local corticosteroid injections 135 0.08 0.74 0.39 -1.68
Rivaroxaban 78 Oral anticoagulants 1,878 0.04 0.24 0.12 -1.67
Tamsulosin hydrochloride 461 Drugs for urinary retention 561 0.82 0.92 0.06 -1.64
Hydroxychloroquine sulfate 18 Rheumatic disease suppressant drugs 155 0.12 0.37 0.16 -1.63
Cabergoline 17 Bromocriptine and other dopaminergic drugs 38 0.45 0.86 0.27 -1.52
Melatonin 24 Hypnotics 1,189 0.02 0.19 0.13 -1.31