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Prototype Prescribing Outlier Dashboard for Fairmore 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 Fairmore Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tetracaine 49 Local anaesthetics 86 0.57 0.02 0.06 8.71
Alkyl sulfate 2 Shampoos and some other scalp preparations 46 0.04 0.00 0.01 6.72
Testosterone esters 15 Male sex hormones and antagonists 93 0.16 0.01 0.02 6.38
Febuxostat 44 Gout and cytotoxic induced hyperiuicaemia 254 0.17 0.02 0.03 5.48
Magnesium oxide 15 Antacids and simeticone 15 1.00 0.05 0.18 5.23
Mefloquine hydrochloride 1 Antimalarials 105 0.01 0.00 0.00 5.10
Felbinac 1 Rubefacients, topical NSAIDS, capsaicin and poultice 224 0.00 0.00 0.00 4.85
Trospium chloride 100 Drugs for urinary frequency enuresis and incontinence 413 0.24 0.04 0.04 4.75
Cyproterone acetate 11 Prostate cancer and gonadorelin analogues 29 0.38 0.03 0.08 4.13
Erythromycin ethylsuccinate 36 Macrolides 138 0.26 0.05 0.05 3.96

Prescribing where Fairmore Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Carbimazole 10 Antithyroid drugs 18 0.56 0.93 0.10 -3.64
Lidocaine hydrochloride 37 Local anaesthetics 86 0.43 0.90 0.13 -3.52
Allopurinol 191 Gout and cytotoxic induced hyperiuicaemia 254 0.75 0.90 0.05 -2.80
Chloramphenicol 41 Antibacterials 74 0.55 0.81 0.11 -2.35
Memantine hydrochloride 0 Drugs for dementia 36 0.00 0.38 0.18 -2.13
    Clotrimazole 4 Antifungal preparations 42 0.10 0.43 0.16 -2.07
    Moxonidine 0 Centrally-acting antihypertensive drugs 10 0.00 0.65 0.33 -1.95
      Dexamethasone 2 Corticosteroids 33 0.06 0.49 0.22 -1.92
      Glucose 3 Treatment of hypoglycaemia 8 0.38 0.75 0.20 -1.89
      Brinzolamide 6 Treatment of glaucoma 299 0.02 0.09 0.04 -1.89