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Prototype Prescribing Outlier Dashboard for Gravesend Alliance 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 Gravesend Alliance PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other soothing haemorrhoidal preparations 5 Soothing haemorrhoidal preparations 22 0.23 0.00 0.02 12.81
Olmesartan medoxomil/hydrochlorothiazide 80 Angiotensin-II receptor antagonists 9,815 0.01 0.00 0.00 6.14
Alogliptin/metformin 429 Other antidiabetic drugs 6,697 0.06 0.00 0.01 5.11
Aceclofenac 33 Non-steroidal anti-inflammatory drugs 5,041 0.01 0.00 0.00 4.98
Ephedrine hydrochloride 3 Systemic nasal decongestants 4 0.75 0.04 0.15 4.67
Promethazine hydrochloride 3,400 Antihistamines 6,441 0.53 0.13 0.09 4.58
Hexetidine 4 Mouth-washes, gargles and dentifrices 36 0.11 0.01 0.02 4.28
Co-fluampicil(Flucloxacillin/ampicillin) 8 Broad-spectrum penicillins 3,593 0.00 0.00 0.00 4.08
Deferasirox 1 Hypoplastic/haemolytic and renal anaemias 2 0.50 0.02 0.13 3.61
Insulin detemir 789 Intermediate and long-acting insulins 2,285 0.35 0.12 0.06 3.58

Prescribing where Gravesend Alliance PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pseudoephedrine hydrochloride 1 Systemic nasal decongestants 4 0.25 0.96 0.15 -4.67
Zinc oxide 7 Soothing haemorrhoidal preparations 22 0.32 0.78 0.13 -3.50
Cetirizine hydrochloride 501 Antihistamines 6,441 0.08 0.28 0.08 -2.58
Oral rehydration salts 44 Oral sodium and water 199 0.22 0.65 0.20 -2.18
Tacrolimus 32 Drugs affecting the immune response 56 0.57 0.80 0.11 -2.16
Clobetasone butyrate 217 Topical corticosteroids 3,235 0.07 0.13 0.03 -2.11
Pizotifen malate 160 Prophylaxis of migraine 448 0.36 0.63 0.13 -2.09
Ibuprofen 258 Rubefacients, topical NSAIDS, capsaicin and poultice 1,278 0.20 0.52 0.16 -2.00
Chlorhexidine gluconate 32 Mouth-washes, gargles and dentifrices 36 0.89 0.98 0.05 -1.92
Loratadine 268 Antihistamines 6,441 0.04 0.12 0.04 -1.83