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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other topical nasal decongestant preparations 2 Topical nasal decongestants 74 0.03 0.00 0.00 7.81
Orphenadrine hydrochloride 16 Antimuscarinic drugs used in parkinsonism 123 0.13 0.01 0.02 7.55
Ciprofloxacin/fluocinolone 26 Otitis externa 571 0.05 0.00 0.01 7.03
Econazole nitrate 20 Vaginal and vulval infections 207 0.10 0.01 0.01 6.71
Podophyllotoxin 5 Preparations for warts and calluses 13 0.38 0.06 0.07 4.93
Fesoterodine fumarate 375 Drugs for urinary frequency enuresis and incontinence 2,599 0.14 0.03 0.03 4.62
Naldemedine 9 Peripheral opioid-receptor antagonists 16 0.56 0.03 0.12 4.45
Dipyridamole and aspirin 1 Antiplatelet drugs 11,319 0.00 0.00 0.00 4.31
Nicardipine hydrochloride 34 Calcium-channel blockers 16,004 0.00 0.00 0.00 4.27
Paraffin soft yellow 7 Emollients 1,947 0.00 0.00 0.00 3.70

Prescribing where Middlewood PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Naloxegol 7 Peripheral opioid-receptor antagonists 16 0.44 0.97 0.13 -4.06
Vitamin A 0 Vitamin A 3 0.00 0.82 0.32 -2.58
    Hydrocortisone 44 Copound haemorrhoidal preparations with corticosteroid 335 0.13 0.56 0.18 -2.34
    Amitriptyline hydrochloride 3,811 Tricyclic and related antidepressant drugs 5,276 0.72 0.84 0.05 -2.21
    Oral rehydration salts 41 Oral sodium and water 188 0.22 0.65 0.20 -2.20
    Dexamethasone 32 Corticosteroids 264 0.12 0.49 0.17 -2.19
    Trimethoprim 342 Sulfonamides and trimethoprim 469 0.73 0.87 0.07 -2.12
    Nitrofurantoin 1,339 Urinary-tract infections 1,541 0.87 0.96 0.05 -1.85
    Sodium chloride 16 Topical nasal decongestants 74 0.22 0.54 0.18 -1.84
    Nicorandil 220 Other antianginal drugs 851 0.26 0.51 0.14 -1.80