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Prototype Prescribing Outlier Dashboard for Essington 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 Essington Medical Centre is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Azithromycin 3 Antibacterials 24 0.12 0.00 0.01 19.16
Lodoxamide trometamol 9 Other anti-inflammatory preparations 19 0.47 0.01 0.04 12.16
Dutasteride 49 Male sex hormones and antagonists 74 0.66 0.06 0.07 8.51
Propylthiouracil 36 Antithyroid drugs 46 0.78 0.07 0.10 6.90
Doxepin 16 Tricyclic and related antidepressant drugs 608 0.03 0.00 0.00 6.60
Exemestane 43 Breast cancer 85 0.51 0.06 0.07 6.56
Meptazinol hydrochloride 36 Opioid analgesics 546 0.07 0.00 0.01 6.00
Soluble insulin (Neutral insulin) 10 Short-acting insulins 71 0.14 0.01 0.02 5.78
Clindamycin phosphate 4 Vaginal and vulval infections 17 0.24 0.03 0.04 5.49
Acetazolamide 44 Treatment of glaucoma 389 0.11 0.01 0.02 5.40

Prescribing where Essington Medical Centre is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Carbimazole 10 Antithyroid drugs 46 0.22 0.93 0.10 -6.90
Clotrimazole 8 Vaginal and vulval infections 17 0.47 0.90 0.09 -5.01
Finasteride 25 Male sex hormones and antagonists 74 0.34 0.82 0.11 -4.22
Trimethoprim 31 Sulfonamides and trimethoprim 63 0.49 0.87 0.12 -3.10
Sodium cromoglicate 2 Other anti-inflammatory preparations 19 0.11 0.64 0.19 -2.84
Prednisolone 326 Use of corticosteroids 445 0.73 0.89 0.06 -2.66
Prochlorperazine maleate 20 Drugs used in nausea and vertigo 319 0.06 0.25 0.08 -2.21
Glyceryl trinitrate 25 Nitrates 383 0.07 0.27 0.10 -1.94
Venlafaxine 76 Other antidepressant drugs 897 0.08 0.26 0.09 -1.93
Tamoxifen citrate 1 Breast cancer 85 0.01 0.27 0.14 -1.90