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Prototype Prescribing Outlier Dashboard for The Limes 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 The Limes Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Demeclocycline hydrochloride 31 Tetracyclines 565 0.05 0.00 0.01 9.45
Valsartan with diuretic 64 Angiotensin-II receptor antagonists 1,294 0.05 0.00 0.01 8.66
Levofloxacin 8 Antibacterials 77 0.10 0.01 0.02 5.90
Loprazolam mesilate 35 Hypnotics 991 0.04 0.00 0.01 5.14
Fenofibrate 235 Lipid-regulating drugs 6,071 0.04 0.01 0.01 4.67
Magnesium oxide 8 Antacids and simeticone 10 0.80 0.05 0.18 4.13
Isophane insulin 126 Intermediate and long-acting insulins 238 0.53 0.12 0.10 4.00
Telmisartan 131 Angiotensin-II receptor antagonists 1,294 0.10 0.01 0.02 3.92
Rizatriptan 67 Treatment of acute migraine 176 0.38 0.10 0.08 3.66
Ferric maltol 9 Oral iron 652 0.01 0.00 0.00 3.59

Prescribing where The Limes Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Terbinafine hydrochloride 18 Other antifungals 20 0.90 0.99 0.03 -2.95
Midazolam hydrochloride 0 Drugs used in status epilepticus 2 0.00 0.80 0.28 -2.82
    Chloramphenicol 41 Antibacterials 77 0.53 0.81 0.11 -2.55
    Alfentanil hydrochloride 0 Opioid analgesics 1 0.00 0.82 0.38 -2.18
      Trimethoprim 61 Sulfonamides and trimethoprim 100 0.61 0.87 0.12 -2.12
      Oral rehydration salts 4 Oral sodium and water 40 0.10 0.71 0.29 -2.08
      Sumatriptan succinate 78 Treatment of acute migraine 176 0.44 0.67 0.12 -1.88
      Mupirocin 0 Antibacterial preparations only used topically 2 0.00 0.64 0.36 -1.79
        Other food for special diet preparations 9 Foods for special diets 39 0.23 0.65 0.24 -1.73
        Furosemide 801 Loop diuretics 1,142 0.70 0.85 0.09 -1.71