Skip to main content

Prototype Prescribing Outlier Dashboard for Ribblesdale Medical Practice

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 Ribblesdale Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cloral betaine 1 Hypnotics 358 0.00 0.00 0.00 22.68
Isometheptene mucate 7 Non-opioid analgesics and compound preparations 3,158 0.00 0.00 0.00 12.10
Acenocoumarol 33 Oral anticoagulants 1,636 0.02 0.00 0.00 6.71
Flupentixol hydrochloride 36 Antipsychotic drugs 640 0.06 0.00 0.01 6.41
Lercanidipine hydrochloride 1,446 Calcium-channel blockers 3,636 0.40 0.06 0.07 4.66
Promazine hydrochloride 113 Antipsychotic drugs 640 0.18 0.01 0.04 4.38
Isophane insulin 170 Intermediate and long-acting insulins 315 0.54 0.12 0.10 4.10
Avanafil 6 Drugs for erectile dysfunction 273 0.02 0.00 0.01 2.86
Erythromycin ethylsuccinate 27 Macrolides 140 0.19 0.05 0.05 2.66
Opicapone 15 Dopaminergic drugs used in parkinsonism 298 0.05 0.01 0.02 2.60

Prescribing where Ribblesdale Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Folic acid 331 Drugs used in megaloblastic anaemias 1,180 0.28 0.69 0.16 -2.62
Amlodipine 1,771 Calcium-channel blockers 3,636 0.49 0.76 0.11 -2.39
Codeine phosphate 0 Cough suppressants 7 0.00 0.74 0.33 -2.22
    Carbimazole 21 Antithyroid drugs 29 0.72 0.93 0.10 -2.01
    Methylprednisolone acetate 0 Local corticosteroid injections 76 0.00 0.74 0.39 -1.89
      Quetiapine 98 Antipsychotic drugs 640 0.15 0.35 0.12 -1.62
      Nicorandil 20 Other antianginal drugs 119 0.17 0.50 0.20 -1.62
      Fluoxetine hydrochloride 293 Selective serotonin re-uptake inhibitors 3,877 0.08 0.16 0.05 -1.62
      Sodium picosulfate 0 Bowel cleansing preparations 1 0.00 0.69 0.43 -1.61
        Rivaroxaban 100 Oral anticoagulants 1,636 0.06 0.24 0.12 -1.50