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Prototype Prescribing Outlier Dashboard for Ribbleton 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 Ribbleton Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Flurbiprofen 8 Non-steroidal anti-inflammatory drugs 894 0.01 0.00 0.00 9.27
Dihydrocodeine tartrate 1,225 Opioid analgesics 3,275 0.37 0.06 0.05 5.98
Diclofenac sodium 2 Ocular diagnostic & peri-operative prepn & photodynamic tt 3 0.67 0.03 0.12 5.14
Levocetirizine 46 Antihistamines 1,082 0.04 0.00 0.01 4.41
Erdosteine 26 Mucolytics 546 0.05 0.00 0.01 3.95
Guanfacine 38 CNS Stimulants and drugs used for ADHD 182 0.21 0.02 0.05 3.69
Varenicline tartrate 5 Nicotine dependence 5 1.00 0.18 0.24 3.35
Lidocaine 2 Topical local anaesthetics and antipruritics 4 0.50 0.08 0.14 2.99
Isometheptene mucate 2 Non-opioid analgesics and compound preparations 3,632 0.00 0.00 0.00 2.92
Paroxetine hydrochloride 469 Selective serotonin re-uptake inhibitors 5,759 0.08 0.03 0.02 2.89

Prescribing where Ribbleton Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Prochlorperazine maleate 38 Drugs used in nausea and vertigo 687 0.06 0.25 0.08 -2.30
Codeine phosphate 0 Cough suppressants 1 0.00 0.74 0.33 -2.22
    Baclofen 95 Skeletal muscle relaxants 211 0.45 0.83 0.18 -2.08
    Zopiclone 66 Hypnotics 209 0.32 0.60 0.14 -2.08
    Nicotine 0 Nicotine dependence 5 0.00 0.65 0.33 -1.95
      Insulin aspart 139 Short-acting insulins 241 0.58 0.79 0.11 -1.89
      Methylprednisolone acetate 0 Local corticosteroid injections 71 0.00 0.74 0.39 -1.89
        Mupirocin 0 Antibacterial preparations only used topically 1 0.00 0.64 0.36 -1.79
          Lamotrigine 228 Control of epilepsy 4,466 0.05 0.11 0.04 -1.46
          Mometasone furoate 12 Topical corticosteroids 839 0.01 0.07 0.04 -1.38