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Prototype Prescribing Outlier Dashboard for The Junction Hth Ctr-Registered Patients

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 Junction Hth Ctr-Registered Patients is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Testosterone propionate 1 Male sex hormones and antagonists 47 0.02 0.00 0.00 178.50
Rotigotine 45 Dopaminergic drugs used in parkinsonism 53 0.85 0.03 0.04 21.53
Testosterone enantate 3 Male sex hormones and antagonists 47 0.06 0.00 0.01 10.13
Glycopyrronium bromide 9 Antispasmodic and other drugs altering gut motility 33 0.27 0.02 0.03 8.64
Febuxostat 32 Gout and cytotoxic induced hyperiuicaemia 136 0.24 0.02 0.03 7.77
Fenofibrate 43 Lipid-regulating drugs 796 0.05 0.01 0.01 6.94
Zonisamide 28 Control of epilepsy 464 0.06 0.01 0.01 6.72
Amiloride hydrochloride 12 Potassium-sparing diuretics and aldosterone antagonists 45 0.27 0.03 0.04 5.87
Prazosin hydrochloride 2 Alpha-adrenoceptor blocking drugs 28 0.07 0.00 0.01 5.54
Ondansetron hydrochloride 16 Drugs used in nausea and vertigo 68 0.24 0.05 0.04 5.32

Prescribing where The Junction Hth Ctr-Registered Patients is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Allopurinol 91 Gout and cytotoxic induced hyperiuicaemia 136 0.67 0.90 0.05 -4.40
Water for injection 0 Electrolytes and water 3 0.00 0.82 0.25 -3.33
    Aciclovir 36 Herpes simplex and varicella-zoster 49 0.73 0.95 0.07 -3.29
    Prednisolone 46 Use of corticosteroids 66 0.70 0.89 0.06 -3.27
    Doxazosin mesilate 26 Alpha-adrenoceptor blocking drugs 28 0.93 0.99 0.02 -3.22
    Midazolam hydrochloride 0 Drugs used in status epilepticus 1 0.00 0.80 0.28 -2.82
      Zinc oxide 1 Soothing haemorrhoidal preparations 11 0.09 0.77 0.26 -2.66
      Sildenafil (Erectile Dysfunction) 55 Drugs for erectile dysfunction 104 0.53 0.77 0.09 -2.59
      Furosemide 27 Loop diuretics 43 0.63 0.85 0.09 -2.54
      Pizotifen malate 0 Prophylaxis of migraine 1 0.00 0.63 0.26 -2.46