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Prototype Prescribing Outlier Dashboard for Yate & Frampton 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 Yate & Frampton PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dextromethorphan hydrobromide 45 Cough suppressants 103 0.44 0.01 0.04 10.00
Hydromorphone hydrochloride 81 Opioid analgesics 13,977 0.01 0.00 0.00 6.52
Vitamin B and C injection 2 Thiamine hydrochloride (B1) 1,115 0.00 0.00 0.00 4.73
Olodaterol 16 Selective beta(2)-agonists 11,243 0.00 0.00 0.00 4.25
Magnesium oxide 32 Antacids and simeticone 50 0.64 0.06 0.14 4.15
Minoxidil 28 Vasodilator antihypertensive drugs 37 0.76 0.12 0.16 4.02
Telmisartan 652 Angiotensin-II receptor antagonists 9,864 0.07 0.01 0.01 3.64
Brinzolamide 976 Treatment of glaucoma 5,273 0.19 0.10 0.03 3.26
Magnesium citrate 3 Bowel cleansing preparations 7 0.43 0.03 0.12 3.22
Lacidipine 1,153 Calcium-channel blockers 17,377 0.07 0.01 0.02 2.91

Prescribing where Yate & Frampton PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Thiamine hydrochloride 1,113 Thiamine hydrochloride (B1) 1,115 1.00 1.00 0.00 -4.73
Hydralazine hydrochloride 9 Vasodilator antihypertensive drugs 37 0.24 0.86 0.17 -3.63
Alfentanil hydrochloride 1 Opioid analgesics 15 0.07 0.84 0.35 -2.17
Procyclidine hydrochloride 76 Antimuscarinic drugs used in parkinsonism 122 0.62 0.85 0.11 -2.12
Calcipotriol 489 Preparations for psoriasis 627 0.78 0.87 0.04 -2.09
Hydrocortisone 81 Use of corticosteroids 4,171 0.02 0.07 0.03 -1.93
Phenoxymethylpenicillin (Penicillin V) 1,214 Benzylpenicillin and phenoxymethylpenicillin 1,215 1.00 1.00 0.00 -1.90
Timolol and bimatoprost 123 Treatment of glaucoma 5,273 0.02 0.10 0.04 -1.90
Salicylic acid 18 Preparations for warts and calluses 74 0.24 0.65 0.22 -1.88
Lactulose 706 Osmotic laxatives 5,177 0.14 0.27 0.07 -1.87