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Prototype Prescribing Outlier Dashboard for Hyndburn Rural 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 Hyndburn Rural PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ephedrine hydrochloride 8 Topical nasal decongestants 75 0.11 0.00 0.01 11.32
Oxazepam 273 Anxiolytics 2,595 0.11 0.01 0.01 6.37
Naphazoline hydrochloride 5 Other anti-inflammatory preparations 386 0.01 0.00 0.00 4.51
Triamterene with thiazides 7 Potassium sparing diuretics and compounds 155 0.05 0.00 0.01 4.47
Triamcinolone acetonide 114 Drugs used in nasal allergy 2,372 0.05 0.01 0.01 4.44
Tolfenamic acid 17 Treatment of acute migraine 1,189 0.01 0.00 0.00 4.43
Tetracaine 45 Local anaesthetics 311 0.14 0.02 0.03 3.65
Formoterol fumarate 176 Selective beta(2)-agonists 9,925 0.02 0.00 0.00 3.62
Varenicline tartrate 35 Nicotine dependence 48 0.73 0.15 0.16 3.59
Fluticasone propionate (Nasal) 757 Drugs used in nasal allergy 2,372 0.32 0.13 0.06 3.44

Prescribing where Hyndburn Rural PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenoxymethylpenicillin (Penicillin V) 725 Benzylpenicillin and phenoxymethylpenicillin 726 1.00 1.00 0.00 -3.33
Clotrimazole 243 Vaginal and vulval infections 317 0.77 0.90 0.05 -2.78
Progesterone 32 Progestogens and progesterone receptor modulators 270 0.12 0.59 0.20 -2.36
Tamsulosin hydrochloride 2,703 Drugs for urinary retention 3,201 0.84 0.92 0.04 -2.01
Fluticasone furoate 52 Drugs used in nasal allergy 2,372 0.02 0.23 0.11 -1.95
Tamoxifen citrate 131 Breast cancer 1,105 0.12 0.27 0.08 -1.94
Nicotine 10 Nicotine dependence 48 0.21 0.68 0.24 -1.93
Combined ethinylestradiol 30mcg 861 Combined hormonal contraceptives 1,174 0.73 0.81 0.04 -1.83
Mirabegron 416 Drugs for urinary frequency enuresis and incontinence 3,207 0.13 0.23 0.06 -1.80
Fluticasone propionate (Inhalation) 758 Corticosteroids (respiratory) 11,302 0.07 0.18 0.06 -1.77