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Prototype Prescribing Outlier Dashboard for North Blaby 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 North Blaby PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Fulvestrant 33 Breast cancer 1,725 0.02 0.00 0.00 11.37
Chlohexidine gluconate (Emollient) 33 Emollients 2,384 0.01 0.00 0.00 11.13
Teicoplanin 24 Some other antibacterials 147 0.16 0.00 0.02 10.15
Ciprofloxacin 199 Otitis externa 1,269 0.16 0.01 0.02 9.28
Alverine citrate/simeticone 11 Antispasmodic and other drugs altering gut motility 2,689 0.00 0.00 0.00 5.85
Sotalol hydrochloride 1,376 Beta-adrenoceptor blocking drugs 26,278 0.05 0.01 0.01 5.70
Fluticasone propionate (Topical) 39 Topical corticosteroids 7,558 0.01 0.00 0.00 5.58
Sodium picosulfate 460 Stimulant laxatives 3,361 0.14 0.03 0.02 4.65
Iron and folic acid 66 Oral iron 4,618 0.01 0.00 0.00 4.14
Nicardipine hydrochloride 60 Calcium-channel blockers 29,463 0.00 0.00 0.00 4.07

Prescribing where North Blaby PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Omeprazole 8,288 Proton pump inhibitors 42,999 0.19 0.51 0.15 -2.10
Umeclidinium bromide/vilanterol 4 Compound bronchodilator preparations 696 0.01 0.50 0.25 -1.98
Fluticasone propionate (Inhalation) 723 Corticosteroids (respiratory) 12,372 0.06 0.18 0.06 -1.91
Aluminium chloride 35 Antiperspirants 38 0.92 0.99 0.04 -1.90
Amoxicillin 3,589 Broad-spectrum penicillins 4,741 0.76 0.85 0.05 -1.73
Docusate sodium 185 Stimulant laxatives 3,361 0.06 0.25 0.12 -1.67
Mometasone furoate 147 Topical corticosteroids 7,558 0.02 0.07 0.03 -1.67
Erythromycin 31 Topical preparations for acne 936 0.03 0.12 0.05 -1.65
Mometasone furoate 747 Drugs used in nasal allergy 4,600 0.16 0.32 0.10 -1.63
Dexamethasone 839 Otitis externa 1,269 0.66 0.78 0.07 -1.62