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Prototype Prescribing Outlier Dashboard for Woodbank Surgery

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 Woodbank Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other bisphosphonate and other preparations 3 Bisphosphonates and other drugs 217 0.01 0.00 0.00 36.09
Levomepromazine hydrochloride 41 Antipsychotic drugs 286 0.14 0.01 0.02 8.43
Spironolactone with loop diuretics 7 Potassium sparing diuretics and compounds 11 0.64 0.01 0.08 8.29
Levobunolol hydrochloride 7 Treatment of glaucoma 273 0.03 0.00 0.00 7.38
Erythromycin stearate 6 Macrolides 113 0.05 0.00 0.01 6.96
Paraffin soft yellow 17 Tear deficiency, eye lubricant/astringent 173 0.10 0.01 0.02 5.58
Sodium fusidate 1 Some other antibacterials 3 0.33 0.01 0.06 5.01
Diclofenac sodium 13 Rubefacients, topical NSAIDS, capsaicin and poultice 252 0.05 0.00 0.01 4.99
Canagliflozin 170 Other antidiabetic drugs 504 0.34 0.05 0.06 4.57
Triptorelin embonate 2 Prostate cancer and gonadorelin analogues 6 0.33 0.03 0.07 4.43

Prescribing where Woodbank Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ivermectin 4 Topical preparation for rosacea 15 0.27 0.88 0.22 -2.75
Folic acid 180 Drugs used in megaloblastic anaemias 615 0.29 0.69 0.16 -2.54
Methylprednisolone acetate 0 Local corticosteroid injections 7 0.00 0.74 0.39 -1.89
    Oral rehydration salts 6 Oral sodium and water 36 0.17 0.71 0.29 -1.85
    Glucose blood testing reagents 250 Diabetic diagnostic and monitoring agents 282 0.89 0.94 0.03 -1.64
    Isosorbide mononitrate 113 Nitrates 202 0.56 0.72 0.11 -1.50
    Lithium carbonate 14 Drugs used for mania and hypomania 58 0.24 0.61 0.28 -1.33
    Estriol 7 Preparations for vaginal/vulval changes 38 0.18 0.45 0.20 -1.32
    Bisoprolol fumarate 820 Beta-adrenoceptor blocking drugs 1,488 0.55 0.65 0.08 -1.29
    Diclofenac diethyl 19 Rubefacients, topical NSAIDS, capsaicin and poultice 252 0.08 0.29 0.18 -1.24