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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Caffeine 33 CNS Stimulants and drugs used for ADHD 539 0.06 0.00 0.00 154.04
Undecenoates 52 Antifungal preparations 929 0.06 0.00 0.00 15.59
Ibuprofen sodium dihydrate 6 Non-steroidal anti-inflammatory drugs 8,689 0.00 0.00 0.00 14.34
Promethazine teoclate 327 Drugs used in nausea and vertigo 4,594 0.07 0.00 0.01 9.79
Ergotamine tartrate 1 Treatment of acute migraine 1,513 0.00 0.00 0.00 8.76
Taurine 7 Amino acids and nutritional agents 7 1.00 0.04 0.16 5.96
Diphenhydramine hydrochloride 244 Antihistamines 10,703 0.02 0.00 0.00 5.89
Metformin hydrochloride/vildagliptin 321 Other antidiabetic drugs 11,971 0.03 0.00 0.00 5.38
Dicycloverine hydrochloride 136 Antispasmodic and other drugs altering gut motility 3,459 0.04 0.01 0.01 5.04
Paraffin soft yellow 18 Emollients 3,889 0.00 0.00 0.00 4.87

Prescribing where Greenwood PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other amino acidandnutritional agent preparations 0 Amino acids and nutritional agents 7 0.00 0.96 0.16 -5.96
    Sodium cromoglicate 1 Cromoglycate and related therapy 2 0.50 0.98 0.13 -3.65
    Budesonide 13 Corticosteroids 37 0.35 0.72 0.18 -2.11
    Azathioprine 533 Antiproliferative immunosuppressants 903 0.59 0.80 0.10 -2.07
    Dexamethasone 36 Use of corticosteroids 3,884 0.01 0.03 0.01 -1.79
    Co-amoxiclav (Amoxicillin/clavulanic acid) 399 Broad-spectrum penicillins 6,381 0.06 0.15 0.05 -1.75
    Tiotropium bromide 913 Antimuscarinic bronchodilators 1,960 0.47 0.71 0.14 -1.68
    Dexamethasone 77 Corticosteroids 360 0.21 0.49 0.17 -1.64
    Brimonidine tartrate 31 Treatment of glaucoma 3,785 0.01 0.03 0.01 -1.64
    Emollient bath and shower preparations 375 Emollient bath and shower preparations 858 0.44 0.64 0.13 -1.56