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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Castor oil 2 Stimulant laxatives 4,869 0.00 0.00 0.00 9.77
Deferasirox 32 Hypoplastic/haemolytic and renal anaemias 36 0.89 0.02 0.13 6.53
Sodium bicarbonate 7 Electrolytes and water 42 0.17 0.00 0.03 6.23
Wool fat 1 Vehicles 1 1.00 0.03 0.17 5.75
Other topical anaesthetic and antipruritic preparations 1 Topical local anaesthetics and antipruritics 170 0.01 0.00 0.00 5.63
Sodium oxybate 9 Hypnotics 2,124 0.00 0.00 0.00 5.56
Clindamycin/tretinoin 133 Topical preparations for acne 1,197 0.11 0.02 0.02 4.57
Betamethasone esters 630 Topical corticosteroids 6,590 0.10 0.03 0.01 4.17
Valproic acid 41 Control of epilepsy 10,932 0.00 0.00 0.00 4.02
Repaglinide 461 Other antidiabetic drugs 15,182 0.03 0.00 0.01 3.88

Prescribing where Loxford PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cetomacrogol 0 Vehicles 1 0.00 0.93 0.24 -3.82
    Water for injection 12 Electrolytes and water 42 0.29 0.82 0.16 -3.37
    Carbimazole 264 Antithyroid drugs 327 0.81 0.93 0.04 -2.91
    Lidocaine hydrochloride 97 Local anaesthetics 132 0.73 0.91 0.07 -2.54
    Aciclovir 180 Herpes simplex and varicella-zoster 206 0.87 0.95 0.04 -2.12
    Quetiapine 1,161 Antipsychotic drugs 6,316 0.18 0.36 0.08 -2.11
    Budesonide 5 Corticosteroids 14 0.36 0.72 0.18 -2.07
    Rifampicin 5 Antituberculosis drugs 48 0.10 0.74 0.34 -1.86
    Beclometdiprop/formoterol/glycopyrronium 67 Selective beta(2)-agonists 9,171 0.01 0.06 0.03 -1.85
    Verapamil hydrochloride 66 Calcium-channel blockers 20,559 0.00 0.01 0.01 -1.79