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Prototype Prescribing Outlier Dashboard for St Ann'S Road 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 St Ann'S Road Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Granisetron hydrochloride 8 Drugs used in nausea and vertigo 678 0.01 0.00 0.00 22.35
Alendronic acid/colecalciferol 20 Bisphosphonates and other drugs 323 0.06 0.00 0.00 13.34
Flurbiprofen 7 Non-steroidal anti-inflammatory drugs 732 0.01 0.00 0.00 9.92
Benzbromarone 1 Gout and cytotoxic induced hyperiuicaemia 338 0.00 0.00 0.00 8.32
Patiromer calcium 4 Oral potassium 7 0.57 0.01 0.07 7.99
Strontium ranelate 4 Bisphosphonates and other drugs 323 0.01 0.00 0.00 7.93
Amiloride hydrochloride with loop diuretics 24 Potassium sparing diuretics and compounds 39 0.62 0.02 0.08 7.38
Belladonna alkaloids 14 Antispasmodic and other drugs altering gut motility 380 0.04 0.00 0.01 5.58
Pyrimethamine 1 Antimalarials 285 0.00 0.00 0.00 5.56
Nalmefene 5 Alcohol dependence 11 0.45 0.01 0.08 5.31

Prescribing where St Ann'S Road Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aciclovir 57 Herpes simplex and varicella-zoster 87 0.66 0.95 0.07 -4.49
Potassium chloride 3 Oral potassium 7 0.43 0.96 0.14 -3.84
Famotidine 28 H2-Receptor antagonists 95 0.29 0.81 0.21 -2.46
Carbimazole 107 Antithyroid drugs 154 0.69 0.93 0.10 -2.29
Co-amilofruse (Amiloride hydrochloride/frusemide) 0 Potassium sparing diuretics and compounds 39 0.00 0.69 0.33 -2.10
    Macrogol 3350 614 Osmotic laxatives 1,200 0.51 0.71 0.10 -2.02
    Quetiapine 195 Antipsychotic drugs 1,300 0.15 0.35 0.12 -1.65
    Sodium picosulfate 0 Bowel cleansing preparations 8 0.00 0.69 0.43 -1.61
      Methotrexate 94 Rheumatic disease suppressant drugs 283 0.33 0.58 0.15 -1.58
      Isosorbide mononitrate 300 Nitrates 536 0.56 0.72 0.11 -1.50