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Prototype Prescribing Outlier Dashboard for Garden City 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 Garden City Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Toremifene citrate 1 Breast cancer 143 0.01 0.00 0.00 29.08
Colestipol hydrochloride 7 Lipid-regulating drugs 4,468 0.00 0.00 0.00 5.76
Erythromycin stearate 6 Macrolides 147 0.04 0.00 0.01 5.28
Oxazepam 33 Anxiolytics 254 0.13 0.01 0.02 5.17
Promazine hydrochloride 98 Antipsychotic drugs 481 0.20 0.01 0.04 5.10
Co-flumactone (Hydroflumethiazide/spironolactone) 2 Potassium sparing diuretics and compounds 23 0.09 0.00 0.02 4.78
Loprazolam mesilate 6 Hypnotics 194 0.03 0.00 0.01 4.47
Sterculia 18 Bulk-forming laxatives 55 0.33 0.04 0.07 4.05
Nicardipine hydrochloride 8 Calcium-channel blockers 2,271 0.00 0.00 0.00 3.71
Amorolfine hydrochloride 25 Antifungal preparations 62 0.40 0.10 0.09 3.46

Prescribing where Garden City Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ispaghula husk 37 Bulk-forming laxatives 55 0.67 0.96 0.07 -4.02
Urea hydrogen peroxide 0 Removal of ear wax and other substances 2 0.00 0.83 0.33 -2.52
    Folic acid 243 Drugs used in megaloblastic anaemias 787 0.31 0.69 0.16 -2.44
    Procyclidine hydrochloride 7 Antimuscarinic drugs used in parkinsonism 16 0.44 0.85 0.21 -1.98
    Pizotifen malate 5 Prophylaxis of migraine 31 0.16 0.63 0.26 -1.83
    Spironolactone 103 Potassium-sparing diuretics and aldosterone antagonists 214 0.48 0.72 0.14 -1.72
    Aripiprazole 11 Antipsychotic drugs 481 0.02 0.13 0.06 -1.70
    Metoclopramide hydrochloride 3 Drugs used in nausea and vertigo 341 0.01 0.11 0.06 -1.60
    Miconazole nitrate 4 Antifungal preparations 62 0.06 0.27 0.13 -1.59
    Tacrolimus 0 Corticosteroids and other immunosuppressants 16 0.00 0.63 0.40 -1.58