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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Diclofenac sodium 417 Rubefacients, topical NSAIDS, capsaicin and poultice 3,687 0.11 0.00 0.00 22.75
Sucralfate 15 Soothing haemorrhoidal preparations 73 0.21 0.00 0.01 13.68
Orphenadrine hydrochloride 10 Antimuscarinic drugs used in parkinsonism 66 0.15 0.01 0.02 8.86
Nedocromil sodium 1 Cromoglycate and related therapy 1 1.00 0.02 0.13 7.47
Chlorhex hydrochloride 1 Preparations for minor cuts and abrasions 3 0.33 0.01 0.05 6.56
Taurine 8 Amino acids and nutritional agents 8 1.00 0.04 0.16 5.96
Terbutaline sulphate 734 Selective beta(2)-agonists 9,701 0.08 0.02 0.01 5.73
Dronabinol/cannabidiol 16 Skeletal muscle relaxants 535 0.03 0.00 0.01 5.65
Sildenafil(Vasodilator Antihypertensive) 1 Vasodilator antihypertensive drugs 3 0.33 0.02 0.06 5.12
Ephedrine hydrochloride 2 Systemic nasal decongestants 3 0.67 0.04 0.15 4.13

Prescribing where Richmondshire PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium cromoglicate 0 Cromoglycate and related therapy 1 0.00 0.98 0.13 -7.47
    Other amino acidandnutritional agent preparations 0 Amino acids and nutritional agents 8 0.00 0.96 0.16 -5.96
      Pseudoephedrine hydrochloride 1 Systemic nasal decongestants 3 0.33 0.96 0.15 -4.13
      Hydralazine hydrochloride 1 Vasodilator antihypertensive drugs 3 0.33 0.86 0.17 -3.10
      Salbutamol 7,919 Selective beta(2)-agonists 9,701 0.82 0.90 0.03 -2.77
      Nitrofurantoin 2,098 Urinary-tract infections 2,475 0.85 0.96 0.05 -2.27
      Vitamin E 0 Vitamin E 8 0.00 0.73 0.33 -2.23
        Ramipril 12,403 Angiotensin-converting enzyme inhibitors 28,108 0.44 0.70 0.14 -1.89
        Procyclidine hydrochloride 43 Antimuscarinic drugs used in parkinsonism 66 0.65 0.85 0.11 -1.86
        Sertraline hydrochloride 7,936 Selective serotonin re-uptake inhibitors 21,902 0.36 0.46 0.06 -1.74