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Prototype Prescribing Outlier Dashboard for Chard, Ilminster & Langport (Click) 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 Chard, Ilminster & Langport (Click) PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenazone/lidocaine 18 Otitis externa 773 0.02 0.00 0.00 20.73
Evolocumab 9 Lipid-regulating drugs 46,946 0.00 0.00 0.00 14.92
Diazoxide 18 Treatment of hypoglycaemia 102 0.18 0.01 0.02 8.37
Sodium fusidate 21 Some other antibacterials 91 0.23 0.01 0.03 7.59
Methenamine hippurate 1,115 Urinary-tract infections 3,029 0.37 0.04 0.05 6.56
Aspirin 121 Non-opioid analgesics and compound preparations 16,350 0.01 0.00 0.00 4.88
Low protein grains/flours 7 Foods for special diets 384 0.02 0.00 0.00 4.76
Flupentixol hydrochloride 96 Antipsychotic drugs 4,742 0.02 0.00 0.00 4.64
Olodaterol 14 Selective beta(2)-agonists 9,483 0.00 0.00 0.00 4.42
Alirocumab 4 Lipid-regulating drugs 46,946 0.00 0.00 0.00 4.25

Prescribing where Chard, Ilminster & Langport (Click) PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nitrofurantoin 1,914 Urinary-tract infections 3,029 0.63 0.96 0.05 -6.56
Glucose 47 Treatment of hypoglycaemia 102 0.46 0.77 0.09 -3.51
Mercaptopurine 13 Antimetabolites 226 0.06 0.81 0.27 -2.75
Neomycin sulfate 136 Nasal preparations for infection 206 0.66 0.83 0.07 -2.51
Trimethoprim 401 Sulfonamides and trimethoprim 562 0.71 0.87 0.07 -2.35
Fusidic acid 137 Antibacterial preparations also used systemically 252 0.54 0.75 0.09 -2.32
Salbutamol 7,901 Selective beta(2)-agonists 9,483 0.83 0.90 0.03 -2.24
Salicylic acid 8 Preparations for warts and calluses 39 0.21 0.65 0.22 -2.05
Sertraline hydrochloride 7,986 Selective serotonin re-uptake inhibitors 23,094 0.35 0.46 0.06 -2.04
Baclofen 282 Skeletal muscle relaxants 485 0.58 0.81 0.12 -1.96