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Prototype Prescribing Outlier Dashboard for Pikes Lane 1

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 Pikes Lane 1 is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Alogliptin/metformin 416 Other antidiabetic drugs 1,589 0.26 0.00 0.02 14.53
Promazine hydrochloride 557 Antipsychotic drugs 1,669 0.33 0.01 0.04 8.53
Dapagliflozin/metformin 122 Other antidiabetic drugs 1,589 0.08 0.00 0.01 6.54
Orphenadrine hydrochloride 31 Antimuscarinic drugs used in parkinsonism 149 0.21 0.01 0.03 6.32
Ertugliflozin 35 Other antidiabetic drugs 1,589 0.02 0.00 0.00 6.12
Naldemedine 8 Peripheral opioid-receptor antagonists 8 1.00 0.04 0.17 5.59
Hexetidine 1 Mouth-washes, gargles and dentifrices 3 0.33 0.01 0.06 5.35
Salmeterol 195 Selective beta(2)-agonists 3,274 0.06 0.01 0.01 4.79
Nebivolol 290 Beta-adrenoceptor blocking drugs 3,229 0.09 0.02 0.02 4.29
Econazole nitrate 18 Vaginal and vulval infections 154 0.12 0.01 0.03 4.07

Prescribing where Pikes Lane 1 is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Naloxegol 0 Peripheral opioid-receptor antagonists 8 0.00 0.96 0.18 -5.44
    Chlorhexidine gluconate 2 Mouth-washes, gargles and dentifrices 3 0.67 0.97 0.11 -2.88
    Glycopyrronium bromide 0 Antimuscarinic drugs 11 0.00 0.82 0.35 -2.34
      Spironolactone 120 Potassium-sparing diuretics and aldosterone antagonists 299 0.40 0.72 0.14 -2.31
      Glucose blood testing reagents 548 Diabetic diagnostic and monitoring agents 631 0.87 0.94 0.03 -2.18
      Amitriptyline hydrochloride 912 Tricyclic and related antidepressant drugs 1,334 0.68 0.84 0.08 -2.08
      Lithium carbonate 4 Drugs used for mania and hypomania 109 0.04 0.61 0.28 -2.07
      Atropine sulfate 0 Mydriatics and cycloplegics 9 0.00 0.72 0.37 -1.93
        Indapamide 148 Thiazides and related diuretics 1,068 0.14 0.43 0.16 -1.83
        Ciprofloxacin 13 Quinolones 21 0.62 0.86 0.14 -1.76