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Prototype Prescribing Outlier Dashboard for Abbey Health 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 Abbey Health PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Low protein risotto 5 Foods for special diets 190 0.03 0.00 0.00 48.63
Hydroxyzine hydrochloride 637 Antihistamines 3,513 0.18 0.03 0.02 10.02
Griseofulvin 6 Other antifungals 42 0.14 0.01 0.02 8.48
Hamamelis 5 Soothing haemorrhoidal preparations 37 0.14 0.00 0.02 7.28
Bezafibrate 304 Lipid-regulating drugs 13,040 0.02 0.00 0.00 7.23
Chloroquine phosphate 5 Antimalarials 373 0.01 0.00 0.00 6.75
Low protein meals 9 Foods for special diets 190 0.05 0.00 0.01 6.58
Norethisterone 108 Oral progestogen-only contraceptives 568 0.19 0.05 0.02 5.62
Magnesium citrate 82 Magnesium 91 0.90 0.07 0.15 5.58
Paracetamol combined preparations 11 Non-opioid analgesics and compound preparations 5,139 0.00 0.00 0.00 5.20

Prescribing where Abbey Health PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Terbinafine hydrochloride 36 Other antifungals 42 0.86 0.99 0.02 -8.48
Desogestrel 448 Oral progestogen-only contraceptives 568 0.79 0.94 0.03 -5.35
Pizotifen malate 14 Prophylaxis of migraine 88 0.16 0.63 0.13 -3.59
Midazolam hydrochloride 3 Drugs used in status epilepticus 16 0.19 0.79 0.17 -3.51
Other emollient preparations 520 Emollients 695 0.75 0.89 0.04 -3.29
Azathioprine 131 Antiproliferative immunosuppressants 243 0.54 0.80 0.10 -2.56
Pregabalin 670 Control of epilepsy 5,060 0.13 0.27 0.06 -2.46
Prednisolone 1,047 Use of corticosteroids 1,281 0.82 0.89 0.03 -2.45
Medroxyprogesterone acetate 82 Parenteral progestogen-only contraceptives 131 0.63 0.86 0.10 -2.27
Emollient bath and shower preparations 16 Emollient bath and shower preparations 45 0.36 0.64 0.13 -2.20