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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Calcitriol 227 Vitamin D 9,402 0.02 0.00 0.00 9.26
Cariprazine 21 Antipsychotic drugs 3,778 0.01 0.00 0.00 9.19
Urine testing reagents 401 Diabetic diagnostic and monitoring agents 3,905 0.10 0.01 0.01 7.58
Flutamide 6 Prostate cancer and gonadorelin analogues 263 0.02 0.00 0.00 5.43
Diflucortolone valerate 11 Topical corticosteroids 4,029 0.00 0.00 0.00 4.34
Quinapril hydrochloride 24 Angiotensin-converting enzyme inhibitors 21,353 0.00 0.00 0.00 3.13
Apraclonidine 3 Ocular diagnostic & peri-operative prepn & photodynamic tt 3 1.00 0.31 0.23 2.99
Fluvoxamine maleate 72 Selective serotonin re-uptake inhibitors 24,204 0.00 0.00 0.00 2.90
Cyanocobalamin 2,686 Drugs used in megaloblastic anaemias 6,831 0.39 0.12 0.10 2.78
Risperidone 16 Antipsychotic depot injections 29 0.55 0.08 0.17 2.78

Prescribing where Winsford PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glucose blood testing reagents 3,352 Diabetic diagnostic and monitoring agents 3,905 0.86 0.94 0.02 -3.58
Prucalopride 15 Other drugs used in constipation 57 0.26 0.73 0.19 -2.54
Furosemide 3,983 Loop diuretics 5,799 0.69 0.85 0.07 -2.32
Folic acid 2,596 Drugs used in megaloblastic anaemias 6,831 0.38 0.68 0.13 -2.25
Rivaroxaban 395 Oral anticoagulants 8,443 0.05 0.24 0.10 -1.89
Senna 969 Stimulant laxatives 2,719 0.36 0.56 0.11 -1.89
Peppermint oil 112 Antispasmodic and other drugs altering gut motility 2,710 0.04 0.12 0.04 -1.79
Budesonide 16 Corticosteroids 38 0.42 0.72 0.18 -1.71
Sodium chloride 17 Topical nasal decongestants 69 0.25 0.54 0.18 -1.67
Dorzolamide and timolol 143 Treatment of glaucoma 3,892 0.04 0.09 0.03 -1.64