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Prototype Prescribing Outlier Dashboard for Regis Healthcare 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 Regis Healthcare PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other topical anaesthetic and antipruritic preparations 2 Topical local anaesthetics and antipruritics 307 0.01 0.00 0.00 6.25
Tolcapone 11 Dopaminergic drugs used in parkinsonism 3,980 0.00 0.00 0.00 6.22
Asenapine 18 Drugs used for mania and hypomania 1,089 0.02 0.00 0.00 5.73
Haemophilus influenzae B/meningococcal C 13 Vaccines and antisera 26,927 0.00 0.00 0.00 4.71
Other vaginal/vulva changes preparations 1 Preparations for vaginal/vulval changes 4,438 0.00 0.00 0.00 4.27
Fosfomycin calcium 2 Urinary-tract infections 4,801 0.00 0.00 0.00 3.86
Loperamide hydrochloride and simeticone 25 Antimotility drugs 1,907 0.01 0.00 0.00 3.42
Fluvastatin sodium 357 Lipid-regulating drugs 77,376 0.00 0.00 0.00 3.13
Levocetirizine 261 Antihistamines 13,158 0.02 0.00 0.00 3.12
Levocarnitine 3 Drugs used in metabolic disorders 3 1.00 0.12 0.31 2.84

Prescribing where Regis Healthcare PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Loperamide hydrochloride 1,882 Antimotility drugs 1,907 0.99 1.00 0.00 -2.19
Amlodipine 26,291 Calcium-channel blockers 43,635 0.60 0.75 0.08 -1.79
Methylprednisolone acetate 156 Local corticosteroid injections 610 0.26 0.73 0.29 -1.64
Erythromycin 112 Macrolides 2,815 0.04 0.11 0.05 -1.52
Sulfasalazine 478 Aminosalicylates 2,452 0.19 0.33 0.09 -1.50
Clobetasone butyrate 859 Topical corticosteroids 10,042 0.09 0.13 0.03 -1.50
Oxybutynin 721 Drugs for urinary frequency enuresis and incontinence 7,615 0.09 0.18 0.05 -1.49
Medroxyprogesterone acetate 362 Parenteral progestogen-only contraceptives 510 0.71 0.86 0.10 -1.46
Co-trimoxazole(Trimethoprim/sulfamethoxazole) 84 Sulfonamides and trimethoprim 2,591 0.03 0.13 0.07 -1.45
Octreotide acetate 0 Somatostatin analogues 2 0.00 0.62 0.43 -1.45