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Prototype Prescribing Outlier Dashboard for Meridian Health Group Nel 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 Meridian Health Group Nel PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Perphenazine 14 Antipsychotic drugs 6,222 0.00 0.00 0.00 12.19
Penciclovir 2 Antiviral preparations 44 0.05 0.00 0.00 11.14
Semaglutide 2,387 Other antidiabetic drugs 6,586 0.36 0.05 0.04 7.73
Nystatin 10 Antifungal preparations 468 0.02 0.00 0.00 5.56
Nicotinamide 5 Topical preparations for acne 336 0.01 0.00 0.00 4.90
Timolol 103 Beta-adrenoceptor blocking drugs 19,558 0.01 0.00 0.00 4.85
Loprazolam mesilate 37 Hypnotics 2,184 0.02 0.00 0.00 4.84
Indometacin 311 Non-steroidal anti-inflammatory drugs 8,076 0.04 0.01 0.01 4.70
Ipratropium bromide 362 Antimuscarinic bronchodilators 1,616 0.22 0.07 0.03 4.68
Ephedrine hydrochloride 7 Systemic nasal decongestants 10 0.70 0.04 0.15 4.35

Prescribing where Meridian Health Group Nel PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aciclovir 42 Antiviral preparations 44 0.95 1.00 0.00 -10.00
Pseudoephedrine hydrochloride 3 Systemic nasal decongestants 10 0.30 0.96 0.15 -4.35
Acamprosate calcium 0 Alcohol dependence 2 0.00 0.83 0.23 -3.54
    Famotidine 93 H2-Receptor antagonists 218 0.43 0.83 0.11 -3.53
    Macrogol 3350 2,450 Osmotic laxatives 4,479 0.55 0.72 0.07 -2.45
    Lithium carbonate 140 Drugs used for mania and hypomania 731 0.19 0.62 0.18 -2.41
    Cabergoline 13 Bromocriptine and other dopaminergic drugs 28 0.46 0.85 0.16 -2.38
    Ivermectin 23 Topical preparation for rosacea 37 0.62 0.89 0.11 -2.30
    Zinc oxide 14 Barrier preparations 534 0.03 0.51 0.23 -2.12
    Apixaban 1,687 Oral anticoagulants 9,793 0.17 0.41 0.12 -1.93