Skip to main content

Prototype Prescribing Outlier Dashboard for The Town Centre 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 Town Centre Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Bilastine 6 Antihistamines 595 0.01 0.00 0.00 12.98
Co-danthramer (Dantron/poloxamer 188) 4 Stimulant laxatives 323 0.01 0.00 0.00 9.34
Labetalol hydrochloride 48 Beta-adrenoceptor blocking drugs 1,145 0.04 0.00 0.00 8.95
Duloxetine hydrochloride 121 Drugs for urinary frequency enuresis and incontinence 336 0.36 0.04 0.04 8.38
Raloxifene hydrochloride 5 Oestrogens and Hormone Replacement Therapy 33 0.15 0.01 0.03 5.48
Estradiol and estriol with progestogen 1 Oestrogens and Hormone Replacement Therapy 33 0.03 0.00 0.01 5.24
Nadolol 6 Beta-adrenoceptor blocking drugs 1,145 0.01 0.00 0.00 5.17
Antazoline 10 Other anti-inflammatory preparations 65 0.15 0.01 0.03 5.12
Trimetazidine hydrochloride 1 Calcium-channel blockers 1,429 0.00 0.00 0.00 4.84
Solifenacin/tamsulosin 10 Drugs for urinary retention 163 0.06 0.01 0.01 3.80

Prescribing where The Town Centre Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Azathioprine 19 Antiproliferative immunosuppressants 54 0.35 0.80 0.19 -2.43
Bendroflumethiazide 60 Thiazides and related diuretics 314 0.19 0.57 0.16 -2.40
Baclofen 24 Skeletal muscle relaxants 59 0.41 0.83 0.18 -2.32
Tamsulosin hydrochloride 129 Drugs for urinary retention 163 0.79 0.92 0.06 -2.15
Isosorbide mononitrate 97 Nitrates 192 0.51 0.72 0.11 -2.01
Betamethasone valerate 72 Topical corticosteroids 475 0.15 0.28 0.07 -1.96
Paracetamol 178 Non-opioid analgesics and compound preparations 1,043 0.17 0.48 0.16 -1.92
Carbamazepine 19 Control of epilepsy 1,211 0.02 0.07 0.03 -1.91
Flecainide acetate 0 Drugs for arrhythmias 18 0.00 0.46 0.25 -1.84
    Citalopram hydrobromide 309 Selective serotonin re-uptake inhibitors 1,746 0.18 0.32 0.08 -1.69