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Prototype Prescribing Outlier Dashboard for Havering South 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 Havering South PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Olanzapine embonate 8 Antipsychotic depot injections 49 0.16 0.00 0.01 15.02
Thioridazine 3 Antipsychotic drugs 7,006 0.00 0.00 0.00 9.70
Cortisone acetate 4 Use of corticosteroids 6,961 0.00 0.00 0.00 9.24
Inosine pranobex 5 Herpes simplex and varicella-zoster 733 0.01 0.00 0.00 5.38
Low protein miscellaneous 8 Foods for special diets 1,089 0.01 0.00 0.00 4.74
Quinapril hydrochloride with diuretic 10 Angiotensin-converting enzyme inhibitors 44,798 0.00 0.00 0.00 4.31
Insulin detemir 1,850 Intermediate and long-acting insulins 4,818 0.38 0.12 0.06 4.19
Dantrolene sodium 81 Skeletal muscle relaxants 710 0.11 0.02 0.03 3.38
Tafluprost and timolol 250 Treatment of glaucoma 11,738 0.02 0.00 0.01 3.34
Other eye tear/lubricant/astringent preparations 176 Tear deficiency, eye lubricant/astringent 3,592 0.05 0.01 0.01 3.33

Prescribing where Havering South PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium permanganate 4 Oxidisers and dyes 10 0.40 0.94 0.19 -2.85
Sodium cromoglicate 361 Other anti-inflammatory preparations 1,006 0.36 0.64 0.12 -2.46
Diazepam 2,424 Anxiolytics 3,955 0.61 0.76 0.08 -1.91
Codeine phosphate 13 Cough suppressants 31 0.42 0.77 0.20 -1.76
Warfarin sodium 1,585 Oral anticoagulants 17,904 0.09 0.23 0.08 -1.75
Carbimazole 685 Antithyroid drugs 797 0.86 0.93 0.04 -1.71
Hydrocortisone 2,791 Topical corticosteroids 10,152 0.27 0.34 0.04 -1.63
Beclometdiprop/formoterol/glycopyrronium 275 Selective beta(2)-agonists 18,265 0.02 0.06 0.03 -1.59
Tiotropium bromide 2,421 Antimuscarinic bronchodilators 5,038 0.48 0.71 0.14 -1.58
Pseudoephedrine hydrochloride 6 Systemic nasal decongestants 8 0.75 0.96 0.15 -1.40