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Prototype Prescribing Outlier Dashboard for Cw Unity 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 Cw Unity PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Fluocinonide 45 Topical corticosteroids 3,880 0.01 0.00 0.00 7.31
Paricalcitol 7 Vitamin D 8,775 0.00 0.00 0.00 6.81
Mianserin hydrochloride 8 Tricyclic and related antidepressant drugs 5,771 0.00 0.00 0.00 6.33
Adefovir dipivoxil 2 Chronic hepatitis B 2 1.00 0.03 0.17 5.64
Calcium polystyrene sulfonate 6 Oral potassium 27 0.22 0.01 0.04 5.44
Vortioxetine 670 Other antidepressant drugs 8,696 0.08 0.01 0.01 5.21
Triptorelin embonate 39 Prostate cancer and gonadorelin analogues 191 0.20 0.02 0.04 4.19
Hepatitis A/typhoid vaccine 27 Vaccines and antisera 1,777 0.02 0.00 0.00 3.88
Aluminium and magnesium and activated simeticone 30 Antacids and simeticone 36 0.83 0.16 0.20 3.42
Hydrocortisone butyrate 56 Topical corticosteroids 3,880 0.01 0.00 0.00 3.29

Prescribing where Cw Unity PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Entecavir 0 Chronic hepatitis B 2 0.00 0.93 0.24 -3.82
    Potassium chloride 20 Oral potassium 27 0.74 0.97 0.07 -3.14
    Diazepam 1,007 Anxiolytics 1,721 0.59 0.76 0.08 -2.26
    Mercaptopurine 27 Antimetabolites 123 0.22 0.81 0.27 -2.16
    Medroxyprogesterone acetate 262 Parenteral progestogen-only contraceptives 410 0.64 0.86 0.10 -2.14
    Mirtazapine 3,597 Other antidepressant drugs 8,696 0.41 0.56 0.07 -2.11
    Nicotine 24 Nicotine dependence 131 0.18 0.68 0.24 -2.04
    Crotamiton 1 Topical local anaesthetics and antipruritics 29 0.03 0.33 0.15 -1.99
    Olanzapine 653 Antipsychotic drugs 5,534 0.12 0.22 0.05 -1.97
    Dexamethasone 20 Use of corticosteroids 2,509 0.01 0.03 0.01 -1.90