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Prototype Prescribing Outlier Dashboard for Solihull South Central PCN

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 PCNs. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given PCN 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 PCN's chemical:subparagraph ratios is provided, with this PCN'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 Solihull South Central PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Low protein miscellaneous 5 Foods for special diets 745 0.01 0.00 0.00 4.31
Amantadine hydrochloride 97 Dopaminergic drugs used in parkinsonism 963 0.10 0.03 0.02 4.06
Rizatriptan 310 Treatment of acute migraine 1,049 0.30 0.11 0.05 3.87
Glycopyrronium bromide 539 Antimuscarinic bronchodilators 1,430 0.38 0.06 0.08 3.78
Amorolfine hydrochloride 101 Antifungal preparations 367 0.28 0.10 0.06 3.21
Low protein biscuits 33 Foods for special diets 745 0.04 0.01 0.01 3.13
Leuprorelin acetate 178 Prostate cancer and gonadorelin analogues 230 0.77 0.25 0.17 3.05
Rivastigmine 23 Drugs for dementia 90 0.26 0.10 0.05 2.93
Other treatment of dry mouth preparations 10 Treatment of dry mouth 10 1.00 0.24 0.30 2.57
Levonorgestrel 12 Emergency contraception 12 1.00 0.60 0.16 2.54

Prescribing where Solihull South Central PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sumatriptan succinate 427 Treatment of acute migraine 1,049 0.41 0.66 0.06 -3.88
Warfarin sodium 31 Oral anticoagulants 4,132 0.01 0.23 0.08 -2.73
Ulipristal acetate (Emergency Contraceptive) 0 Emergency contraception 12 0.00 0.40 0.16 -2.54
    Sertraline hydrochloride 4,399 Selective serotonin re-uptake inhibitors 12,496 0.35 0.46 0.06 -1.93
    Goserelin acetate 1 Prostate cancer and gonadorelin analogues 230 0.00 0.29 0.17 -1.72
    Calcium carbonate 68 Calcium supplements 78 0.87 0.96 0.05 -1.68
    Olanzapine 373 Antipsychotic drugs 2,701 0.14 0.22 0.05 -1.60
    Ipratropium bromide 8 Topical nasal decongestants 107 0.07 0.36 0.18 -1.60
    Bisacodyl 105 Stimulant laxatives 3,644 0.03 0.13 0.06 -1.55
    Hydroxychloroquine sulfate 158 Rheumatic disease suppressant drugs 832 0.19 0.36 0.11 -1.53