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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Bupivacaine hydrochloride 260 Local anaesthetics 646 0.40 0.01 0.03 12.13
Lidocaine hydrochloride 1 Topical local anaesthetics and antipruritics 86 0.01 0.00 0.00 11.19
Salbutamol 171 Compound bronchodilator preparations 777 0.22 0.01 0.02 8.81
Other expectorantand demulcent cough preparations 13 Expectorant and demulcent cough preparations 156 0.08 0.00 0.01 7.12
Naldemedine 10 Peripheral opioid-receptor antagonists 13 0.77 0.03 0.12 6.17
Fenofibrate 1,191 Lipid-regulating drugs 38,039 0.03 0.01 0.00 5.55
Fondaparinux sodium 11 Parenteral anticoagulants 95 0.12 0.01 0.02 5.47
Alimemazine tartrate 101 Antihistamines 7,388 0.01 0.00 0.00 5.39
Hydrocortisone 47 Otitis externa 765 0.06 0.01 0.01 5.24
Latanoprost and timolol 462 Treatment of glaucoma 3,151 0.15 0.04 0.02 4.99

Prescribing where Hindley PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Naloxegol 3 Peripheral opioid-receptor antagonists 13 0.23 0.97 0.13 -5.64
Lidocaine hydrochloride 361 Local anaesthetics 646 0.56 0.91 0.07 -5.02
Baclofen 463 Skeletal muscle relaxants 960 0.48 0.81 0.12 -2.81
Aluminium chloride 24 Antiperspirants 27 0.89 0.99 0.04 -2.76
Cabergoline 34 Bromocriptine and other dopaminergic drugs 77 0.44 0.85 0.16 -2.52
Timolol and bimatoprost 37 Treatment of glaucoma 3,151 0.01 0.10 0.04 -2.17
Codeine phosphate 36 Cough suppressants 97 0.37 0.77 0.20 -2.00
Empagliflozin 143 Other antidiabetic drugs 6,994 0.02 0.15 0.07 -1.83
Paracetamol 7,197 Non-opioid analgesics and compound preparations 28,321 0.25 0.50 0.13 -1.82
Carbamazepine 862 Control of epilepsy 19,797 0.04 0.07 0.02 -1.81