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Prototype Prescribing Outlier Dashboard for The Havens 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 The Havens PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tafluprost 119 Treatment of glaucoma 2,749 0.04 0.01 0.01 5.57
Acebutolol hydrochloride 28 Beta-adrenoceptor blocking drugs 13,968 0.00 0.00 0.00 5.41
Gluten free/wheat free grains/flours 10 Foods for special diets 528 0.02 0.00 0.00 5.32
Sodium citrate 13 Drugs used in urological pain 14 0.93 0.07 0.18 4.70
Omega-3-acid ethyl esters 153 Lipid-regulating drugs 25,885 0.01 0.00 0.00 4.14
Paraffin soft yellow 36 Tear deficiency, eye lubricant/astringent 880 0.04 0.01 0.01 4.06
Vitamins caps 662 Multivitamin preparations 971 0.68 0.19 0.14 3.54
Ciprofibrate 35 Lipid-regulating drugs 25,885 0.00 0.00 0.00 3.12
Cod liver oil 1 Vitamin A 1 1.00 0.15 0.30 2.87
Ciprofloxacin 57 Antibacterials 341 0.17 0.05 0.04 2.73

Prescribing where The Havens PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium citrate 1 Drugs used in urological pain 14 0.07 0.93 0.19 -4.45
Other multivitamin preparations 309 Multivitamin preparations 971 0.32 0.81 0.14 -3.54
Chloramphenicol 207 Antibacterials 341 0.61 0.80 0.06 -3.13
Vitamin A 0 Vitamin A 1 0.00 0.82 0.32 -2.58
    Nicotine 10 Nicotine dependence 52 0.19 0.68 0.24 -2.00
    Spironolactone 891 Potassium-sparing diuretics and aldosterone antagonists 1,676 0.53 0.72 0.10 -1.95
    Ticagrelor 25 Antiplatelet drugs 10,888 0.00 0.02 0.01 -1.87
    Clonidine hydrochloride 24 Prophylaxis of migraine 191 0.13 0.37 0.13 -1.83
    Medroxyprogesterone acetate 218 Parenteral progestogen-only contraceptives 317 0.69 0.86 0.10 -1.68
    Lorazepam 267 Anxiolytics 3,354 0.08 0.19 0.07 -1.67