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Prototype Prescribing Outlier Dashboard for Cantab Medical Practices 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 Cantab Medical Practices PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other bisphosphonate and other preparations 7 Bisphosphonates and other drugs 1,920 0.00 0.00 0.00 15.16
Hydrocortisone 57 Otitis externa 448 0.13 0.01 0.01 11.72
Fenofibrate/simvastatin 1 Lipid-regulating drugs 16,475 0.00 0.00 0.00 11.63
Chlortalidone 45 Thiazides and related diuretics 2,128 0.02 0.00 0.00 9.71
Magnesium lactate 10 Magnesium 34 0.29 0.01 0.04 7.20
Phenobarbital sodium 1 Control of epilepsy 5,442 0.00 0.00 0.00 7.19
Azelastine hydrochloride 59 Drugs used in nasal allergy 1,354 0.04 0.01 0.01 7.06
Meningococcal B vaccine 2 Vaccines and antisera 3,285 0.00 0.00 0.00 6.49
Hamamelis 3 Soothing haemorrhoidal preparations 25 0.12 0.00 0.02 6.44
Benzydamine hydrochloride 2 Rubefacients, topical NSAIDS, capsaicin and poultice 676 0.00 0.00 0.00 6.38

Prescribing where Cantab Medical Practices PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pseudoephedrine hydrochloride 0 Systemic nasal decongestants 4 0.00 0.96 0.15 -6.31
    Theophylline 44 Theophylline 80 0.55 0.93 0.08 -4.44
    Trimethoprim 222 Sulfonamides and trimethoprim 362 0.61 0.87 0.07 -3.86
    Moxonidine 0 Centrally-acting antihypertensive drugs 22 0.00 0.69 0.19 -3.53
      Ispaghula husk 174 Bulk-forming laxatives 208 0.84 0.96 0.04 -2.88
      Benzydamine hydrochloride 40 Drugs for oral ulceration and inflammation 61 0.66 0.85 0.08 -2.55
      Neomycin sulfate 71 Nasal preparations for infection 108 0.66 0.83 0.07 -2.55
      Doxazosin mesilate 834 Alpha-adrenoceptor blocking drugs 865 0.96 0.99 0.01 -2.48
      Famotidine 247 H2-Receptor antagonists 441 0.56 0.83 0.11 -2.35
      Levothyroxine sodium 8,482 Thyroid hormones 8,531 0.99 1.00 0.00 -2.21