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Prototype Prescribing Outlier Dashboard for Beeston 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 Beeston PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Timolol with diuretic 41 Beta-adrenoceptor blocking drugs 13,778 0.00 0.00 0.00 158.86
Quinapril hydrochloride 50 Angiotensin-converting enzyme inhibitors 15,283 0.00 0.00 0.00 9.86
Beclometasone dipropionate 9 Topical corticosteroids 4,862 0.00 0.00 0.00 5.49
Methylprednisolone sodium succinate 1 Use of corticosteroids 2,330 0.00 0.00 0.00 5.00
Patiromer calcium 10 Oral potassium 71 0.14 0.01 0.03 4.41
Acetic acid 129 Otitis externa 734 0.18 0.04 0.03 4.32
Azithromycin 6 Antibacterials 409 0.01 0.00 0.00 4.27
Mycophenolic sodium 36 Antiproliferative immunosuppressants 629 0.06 0.01 0.01 4.16
Disopyramide phosphate 8 Drugs for arrhythmias 157 0.05 0.00 0.01 4.11
Timolol 59 Beta-adrenoceptor blocking drugs 13,778 0.00 0.00 0.00 3.89

Prescribing where Beeston PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Azathioprine 366 Antiproliferative immunosuppressants 629 0.58 0.80 0.10 -2.15
Ganciclovir 0 Antivirals 8 0.00 0.65 0.33 -2.00
    Mebeverine hydrochloride 826 Antispasmodic and other drugs altering gut motility 2,549 0.32 0.45 0.07 -1.97
    Isosorbide mononitrate 1,320 Nitrates 2,213 0.60 0.73 0.07 -1.95
    Moxonidine 32 Centrally-acting antihypertensive drugs 97 0.33 0.69 0.19 -1.84
    Insulin aspart 610 Short-acting insulins 955 0.64 0.79 0.09 -1.79
    Venlafaxine 1,114 Other antidepressant drugs 7,139 0.16 0.27 0.06 -1.78
    Nicotine 22 Nicotine dependence 84 0.26 0.68 0.24 -1.71
    Omeprazole 6,734 Proton pump inhibitors 26,311 0.26 0.51 0.15 -1.68
    Combined ethinylestradiol 30mcg 541 Combined hormonal contraceptives 729 0.74 0.81 0.04 -1.62