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Prototype Prescribing Outlier Dashboard for Ripon & Masham 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 Ripon & Masham PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Rilpivirine 1 HIV infection 1 1.00 0.00 0.06 17.88
Cefuroxime sodium 1 Antibacterials 350 0.00 0.00 0.00 16.47
Benzbromarone 7 Gout and cytotoxic induced hyperiuicaemia 3,676 0.00 0.00 0.00 7.63
Ketamine hydrochloride 10 Drugs used in nausea and vertigo 1,881 0.01 0.00 0.00 6.40
Diclofenac sodium 89 Rubefacients, topical NSAIDS, capsaicin and poultice 2,862 0.03 0.00 0.00 5.93
Dimeticone (Parasiticidal) 11 Parasiticidal preparations 30 0.37 0.03 0.06 5.59
Celecoxib 722 Non-steroidal anti-inflammatory drugs 4,574 0.16 0.03 0.02 5.24
Insulin degludec 674 Intermediate and long-acting insulins 1,548 0.44 0.11 0.06 5.15
Low protein cooking aids 7 Foods for special diets 508 0.01 0.00 0.00 5.10
Benzylpenicillin sodium (Penicillin G) 1 Benzylpenicillin and phenoxymethylpenicillin 524 0.00 0.00 0.00 4.70

Prescribing where Ripon & Masham PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenoxymethylpenicillin (Penicillin V) 523 Benzylpenicillin and phenoxymethylpenicillin 524 1.00 1.00 0.00 -4.70
Carbimazole 112 Antithyroid drugs 151 0.74 0.93 0.04 -4.42
Carbocisteine 585 Mucolytics 909 0.64 0.97 0.08 -4.15
Sodium bicarbonate 153 Oral bicarbonate 154 0.99 1.00 0.00 -3.99
Procyclidine hydrochloride 51 Antimuscarinic drugs used in parkinsonism 120 0.42 0.85 0.11 -3.96
Nitrofurantoin 1,142 Urinary-tract infections 1,452 0.79 0.96 0.05 -3.49
Famotidine 299 H2-Receptor antagonists 677 0.44 0.83 0.11 -3.40
Benzoyl peroxide and clindamycin phosphate 74 Topical preparations for acne 446 0.17 0.37 0.07 -2.73
Estradiol with progestogen 552 Oestrogens and Hormone Replacement Therapy 2,629 0.21 0.38 0.07 -2.44
Other emollient preparations 1,160 Emollients 1,472 0.79 0.89 0.04 -2.38