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Prototype Prescribing Outlier Dashboard for Bradford North West 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 Bradford North West PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tacalcitol 84 Preparations for psoriasis 545 0.15 0.00 0.01 13.47
Squill 2 Expectorant and demulcent cough preparations 16 0.12 0.00 0.01 10.23
Other bisphosphonate and other preparations 6 Bisphosphonates and other drugs 2,909 0.00 0.00 0.00 8.52
Zuclopenthixol hydrochloride 530 Antipsychotic drugs 8,034 0.07 0.01 0.01 7.71
Isotretinoin 115 Oral preparations for acne 121 0.95 0.03 0.12 7.60
Glimepiride 6,012 Sulfonylureas 6,901 0.87 0.07 0.11 7.24
Risedronate sodium 1,605 Bisphosphonates and other drugs 2,909 0.55 0.09 0.07 6.84
Nystatin 20 Antifungal preparations 821 0.02 0.00 0.00 6.40
Maltodextrin 42 Foods for special diets 591 0.07 0.01 0.01 6.10
Mycophenolic sodium 61 Antiproliferative immunosuppressants 793 0.08 0.01 0.01 5.76

Prescribing where Bradford North West PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-cyprindiol (Cyprote acetate/ethinylestradiol) 6 Oral preparations for acne 121 0.05 0.97 0.12 -7.60
Gliclazide 889 Sulfonylureas 6,901 0.13 0.93 0.11 -7.19
Alendronic acid 1,027 Bisphosphonates and other drugs 2,909 0.35 0.87 0.07 -7.00
Calcipotriol 381 Preparations for psoriasis 545 0.70 0.87 0.04 -3.97
Betamethasone valerate 1,025 Topical corticosteroids 7,225 0.14 0.28 0.04 -3.17
Prucalopride 18 Other drugs used in constipation 82 0.22 0.73 0.19 -2.77
Cefalexin 220 Cephalosporins 270 0.81 0.96 0.05 -2.74
Other amino acidandnutritional agent preparations 8 Amino acids and nutritional agents 15 0.53 0.96 0.16 -2.65
Emollient bath and shower preparations 431 Emollient bath and shower preparations 1,431 0.30 0.64 0.13 -2.62
Carbimazole 215 Antithyroid drugs 261 0.82 0.93 0.04 -2.53