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Prototype Prescribing Outlier Dashboard for Mayday South 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 Mayday South PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cholera 13 Vaccines and antisera 2,188 0.01 0.00 0.00 28.47
Paracetamol and ibuprofen 11 Non-opioid analgesics and compound preparations 12,094 0.00 0.00 0.00 20.32
Heparin sodium 1 Parenteral anticoagulants 20 0.05 0.00 0.00 11.16
Meningococcal B vaccine 2 Vaccines and antisera 2,188 0.00 0.00 0.00 9.83
Doxepin hydrochloride 11 Topical local anaesthetics and antipruritics 59 0.19 0.01 0.03 6.53
Diethylamine salicylate 432 Rubefacients, topical NSAIDS, capsaicin and poultice 1,808 0.24 0.02 0.04 5.45
Oestrogens conjugated with progestogen 28 Oestrogens and Hormone Replacement Therapy 565 0.05 0.01 0.01 5.10
Piracetam 3 Essential tremor,chorea,tics and related disorders 3 1.00 0.13 0.24 3.59
Cetylpyridinium chloride 4 Mouth-washes, gargles and dentifrices 113 0.04 0.00 0.01 3.53
Alkyl sulfate 7 Shampoos and some other scalp preparations 601 0.01 0.00 0.00 3.49

Prescribing where Mayday South PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Colecalciferol 8,222 Vitamin D 8,888 0.93 0.97 0.01 -2.85
Methotrexate 407 Rheumatic disease suppressant drugs 1,413 0.29 0.58 0.11 -2.71
Co-amilofruse (Amiloride hydrochloride/frusemide) 4 Potassium sparing diuretics and compounds 19 0.21 0.70 0.19 -2.63
Mirabegron 189 Drugs for urinary frequency enuresis and incontinence 1,883 0.10 0.23 0.06 -2.33
Rifampicin 0 Antituberculosis drugs 9 0.00 0.74 0.34 -2.17
    Sodium picosulfate 0 Bowel cleansing preparations 3 0.00 0.70 0.35 -2.04
      Fluorouracil (Sunscreen) 1 Sunscreening preparations 34 0.03 0.46 0.22 -1.93
      Progesterone 50 Progestogens and progesterone receptor modulators 235 0.21 0.59 0.20 -1.89
      Fexofenadine hydrochloride 1,299 Antihistamines 7,052 0.18 0.35 0.09 -1.85
      Gentamicin sulfate 0 Aminoglycosides 1 0.00 0.74 0.41 -1.80