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Prototype Prescribing Outlier Dashboard for Witham & Maldon 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 Witham & Maldon PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Benzocaine 7 Drugs for oral ulceration and inflammation 102 0.07 0.00 0.01 7.80
Calcium acetate/magnesium carbonate 8 Phosphate binding agents 8 1.00 0.05 0.14 6.95
Atropine sulfate 8 Antimuscarinic drugs 25 0.32 0.00 0.05 6.30
Tioconazole 18 Antifungal preparations 297 0.06 0.01 0.01 4.85
Desloratadine 340 Antihistamines 5,825 0.06 0.01 0.01 4.38
Aluminium and magnesium and activated simeticone 4 Antacids and simeticone 4 1.00 0.16 0.20 4.27
Silver nitrate 3 Preparations for warts and calluses 7 0.43 0.07 0.08 4.27
Paraldehyde 10 Drugs used in status epilepticus 36 0.28 0.02 0.06 4.23
Methylprednisolone sodium succinate 1 Use of corticosteroids 2,846 0.00 0.00 0.00 4.07
Lidocaine 10 Topical local anaesthetics and antipruritics 30 0.33 0.07 0.06 4.05

Prescribing where Witham & Maldon PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Fluconazole 155 Triazole antifungals 234 0.66 0.86 0.07 -2.95
Theophylline 100 Theophylline 147 0.68 0.93 0.08 -2.90
Other multivitamin preparations 88 Multivitamin preparations 208 0.42 0.81 0.14 -2.78
Hyoscine butylbromide 369 Antispasmodic and other drugs altering gut motility 2,068 0.18 0.33 0.06 -2.50
Amiodarone hydrochloride 95 Drugs for arrhythmias 707 0.13 0.48 0.15 -2.28
Adapalene 12 Topical preparations for acne 442 0.03 0.11 0.04 -2.02
Naftidrofuryl oxalate 4 Peripheral vasodilators and related drugs 30 0.13 0.67 0.28 -1.96
Paracetamol 2,609 Non-opioid analgesics and compound preparations 10,704 0.24 0.50 0.13 -1.90
Zinc oxide 15 Barrier preparations 185 0.08 0.51 0.23 -1.88
Cyclizine hydrochloride 231 Drugs used in nausea and vertigo 2,570 0.09 0.17 0.04 -1.86