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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Naphazoline hydrochloride 4 Other anti-inflammatory preparations 255 0.02 0.00 0.00 5.52
Nimodipine 7 Calcium-channel blockers 18,379 0.00 0.00 0.00 5.49
Tenoxicam 3 Non-steroidal anti-inflammatory drugs 4,863 0.00 0.00 0.00 5.07
Low protein meals 15 Foods for special diets 427 0.04 0.00 0.01 4.79
Azelastine hydrochloride 60 Other anti-inflammatory preparations 255 0.24 0.06 0.04 4.59
Dihydrocodeine tartrate 3,362 Opioid analgesics 14,272 0.24 0.06 0.04 4.55
Canagliflozin/metformin 57 Other antidiabetic drugs 5,904 0.01 0.00 0.00 4.37
Esomeprazole 3,153 Proton pump inhibitors 29,753 0.11 0.03 0.02 4.36
Trifluoperazine 58 Antipsychotic drugs 3,188 0.02 0.00 0.00 4.10
Levocetirizine 102 Antihistamines 4,482 0.02 0.00 0.00 3.71

Prescribing where Leyland PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Water for injection 73 Electrolytes and water 221 0.33 0.82 0.16 -3.08
Carbimazole 188 Antithyroid drugs 234 0.80 0.93 0.04 -3.00
Insulin aspart 710 Short-acting insulins 1,189 0.60 0.79 0.09 -2.28
Zinc sulfate monohydrate 0 Zinc 16 0.00 0.74 0.33 -2.26
    Vitamin E 0 Vitamin E 3 0.00 0.73 0.33 -2.23
      Levonorgestrel 3 Emergency contraception 11 0.27 0.60 0.16 -2.04
      Cetirizine hydrochloride 598 Antihistamines 4,482 0.13 0.28 0.08 -1.87
      Sodium cromoglicate 109 Other anti-inflammatory preparations 255 0.43 0.64 0.12 -1.86
      Zinc oxide 10 Barrier preparations 116 0.09 0.51 0.23 -1.86
      Prucalopride 37 Other drugs used in constipation 90 0.41 0.73 0.19 -1.74