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Prototype Prescribing Outlier Dashboard for Limelight Health And Wellbeing Hub

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 Limelight Health And Wellbeing Hub is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Salicylic acid 7 Preparations for psoriasis 87 0.08 0.00 0.01 9.31
Chlorhexidine gluconate 1 Preparations for minor cuts and abrasions 1 1.00 0.02 0.13 7.72
Flavoxate hydrochloride 36 Drugs for urinary frequency enuresis and incontinence 1,138 0.03 0.00 0.01 5.43
Domperidone 220 Drugs used in nausea and vertigo 929 0.24 0.05 0.04 4.43
Hydrogen peroxide 3 Oxidisers and dyes 3 1.00 0.06 0.22 4.30
Oxycodone hydrochloride 587 Opioid analgesics 2,108 0.28 0.08 0.05 4.00
Canagliflozin/metformin 51 Other antidiabetic drugs 3,635 0.01 0.00 0.00 3.28
Hyoscine butylbromide 490 Antispasmodic and other drugs altering gut motility 701 0.70 0.33 0.12 3.17
Quinine bisulfate 149 Antimalarials 290 0.51 0.10 0.13 3.06
Empagliflozin/linagliptin 14 Other antidiabetic drugs 3,635 0.00 0.00 0.00 2.92

Prescribing where Limelight Health And Wellbeing Hub is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium permanganate 0 Oxidisers and dyes 3 0.00 0.94 0.22 -4.23
    Quinine sulfate 141 Antimalarials 290 0.49 0.90 0.14 -3.02
    Colecalciferol 2,597 Vitamin D 2,884 0.90 0.96 0.02 -2.57
    Prednisolone 462 Use of corticosteroids 610 0.76 0.89 0.06 -2.24
    Budesonide 0 Corticosteroids 5 0.00 0.71 0.32 -2.21
      Mebeverine hydrochloride 133 Antispasmodic and other drugs altering gut motility 701 0.19 0.45 0.12 -2.10
      Venlafaxine 298 Other antidepressant drugs 3,146 0.09 0.26 0.09 -1.82
      Lithium carbonate 64 Drugs used for mania and hypomania 596 0.11 0.61 0.28 -1.81
      Timolol and bimatoprost 10 Treatment of glaucoma 1,075 0.01 0.10 0.05 -1.76
      Naproxen 649 Non-steroidal anti-inflammatory drugs 1,259 0.52 0.69 0.10 -1.75