Skip to main content

Prototype Prescribing Outlier Dashboard for Cygnet 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 Cygnet PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Atropine sulfate 1 Antimuscarinic drugs 1 1.00 0.00 0.05 19.88
Spironolactone with loop diuretics 8 Potassium sparing diuretics and compounds 20 0.40 0.01 0.04 10.30
Clindamycin phosphate 180 Topical preparations for acne 785 0.23 0.06 0.03 6.21
Flubiprofen 5 Drugs for oral ulceration and inflammation 151 0.03 0.00 0.01 4.97
Opicapone 54 Dopaminergic drugs used in parkinsonism 1,213 0.04 0.01 0.01 3.73
Rutosides 2 Peripheral vasodilators and related drugs 4 0.50 0.06 0.12 3.71
Clobazam 239 Control of epilepsy 7,591 0.03 0.01 0.01 3.59
Colistimethate sodium 12 Some other antibacterials 18 0.67 0.15 0.15 3.51
Cyproterone acetate 40 Prostate cancer and gonadorelin analogues 264 0.15 0.03 0.04 3.14
Cefradine 18 Cephalosporins 102 0.18 0.02 0.05 3.13

Prescribing where Cygnet PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cefalexin 81 Cephalosporins 102 0.79 0.96 0.05 -3.12
Pregabalin 816 Control of epilepsy 7,591 0.11 0.27 0.06 -2.91
Levothyroxine sodium 8,166 Thyroid hormones 8,217 0.99 1.00 0.00 -2.47
Doxycycline hyclate 564 Tetracyclines 1,154 0.49 0.70 0.08 -2.47
Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 4 0.00 0.67 0.28 -2.44
    Codeine phosphate 15 Cough suppressants 46 0.33 0.77 0.20 -2.23
    Tacrolimus 0 Corticosteroids and other immunosuppressants 32 0.00 0.61 0.28 -2.16
      Hydrocortisone 1,188 Topical corticosteroids 4,664 0.25 0.34 0.04 -2.15
      Glycopyrronium bromide 0 Antimuscarinic drugs 1 0.00 0.78 0.36 -2.14
        Umeclidinium bromide/vilanterol 4 Compound bronchodilator preparations 318 0.01 0.50 0.25 -1.96