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Prototype Prescribing Outlier Dashboard for Smartcare Central 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 Smartcare Central PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Perindopril with calcium channel blocker 1 Angiotensin-converting enzyme inhibitors 17,149 0.00 0.00 0.00 8.28
Aspirin and caffeine 1 Non-opioid analgesics and compound preparations 21,453 0.00 0.00 0.00 6.33
Fenofibrate/simvastatin 1 Lipid-regulating drugs 37,359 0.00 0.00 0.00 5.08
Bambuterol hydrochloride 36 Selective beta(2)-agonists 14,990 0.00 0.00 0.00 4.54
Doxylamine succinate/pyridoxine hydrochloride 44 Drugs used in nausea and vertigo 3,349 0.01 0.00 0.00 4.37
Analgesics with anti-emetics 203 Treatment of acute migraine 1,359 0.15 0.03 0.03 4.25
Low protein snacks 12 Foods for special diets 1,264 0.01 0.00 0.00 4.17
Mercaptamine 3 Drugs used in metabolic disorders 3 1.00 0.07 0.24 3.88
Ephedrine hydrochloride 6 Topical nasal decongestants 163 0.04 0.00 0.01 3.67
Low protein miscellaneous 7 Foods for special diets 1,264 0.01 0.00 0.00 3.51

Prescribing where Smartcare Central PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Warfarin sodium 82 Oral anticoagulants 3,608 0.02 0.23 0.08 -2.55
Calcium carbonate 118 Calcium supplements 141 0.84 0.96 0.05 -2.37
Permethrin 102 Parasiticidal preparations 172 0.59 0.84 0.11 -2.21
Budesonide 10 Corticosteroids 30 0.33 0.72 0.18 -2.21
Clotrimazole 300 Antifungal preparations 1,442 0.21 0.44 0.11 -2.18
Clopidogrel 3,318 Antiplatelet drugs 13,982 0.24 0.33 0.04 -2.07
Prucalopride 74 Other drugs used in constipation 197 0.38 0.73 0.19 -1.93
Fexofenadine hydrochloride 1,917 Antihistamines 10,429 0.18 0.35 0.09 -1.85
Codeine phosphate 117 Cough suppressants 289 0.40 0.77 0.20 -1.83
Dexamethasone 27 Use of corticosteroids 3,020 0.01 0.03 0.01 -1.82