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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Saxagliptin 865 Other antidiabetic drugs 5,026 0.17 0.01 0.02 9.48
Linezolid 7 Some other antibacterials 45 0.16 0.01 0.02 8.78
Gluten free/low protein mixes 17 Foods for special diets 418 0.04 0.00 0.00 8.63
Disopyramide phosphate 24 Drugs for arrhythmias 247 0.10 0.00 0.01 8.18
Aprepitant 7 Drugs used in nausea and vertigo 2,046 0.00 0.00 0.00 8.05
Clemastine fumarate 6 Antihistamines 3,763 0.00 0.00 0.00 7.32
Antazoline 16 Other anti-inflammatory preparations 158 0.10 0.01 0.01 7.15
Alimemazine tartrate 65 Antihistamines 3,763 0.02 0.00 0.00 7.02
Gluten free/low protein pasta 35 Foods for special diets 418 0.08 0.01 0.01 6.34
Low protein biscuits 28 Foods for special diets 418 0.07 0.01 0.01 5.02

Prescribing where Rosebank PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Somatropin 0 Hypothalamic & anterior pituitary hormone & antioestrogens 3 0.00 0.89 0.25 -3.54
    Insulin aspart 491 Short-acting insulins 938 0.52 0.79 0.09 -3.15
    Light liquid paraffin 1 Emollient bath and shower preparations 70 0.01 0.33 0.13 -2.52
    Cabergoline 8 Bromocriptine and other dopaminergic drugs 18 0.44 0.85 0.16 -2.51
    Senna 1,213 Stimulant laxatives 4,034 0.30 0.56 0.11 -2.41
    Naloxegol 52 Peripheral opioid-receptor antagonists 76 0.68 0.97 0.13 -2.18
    Nicotine 7 Nicotine dependence 32 0.22 0.68 0.24 -1.89
    Midazolam hydrochloride 23 Drugs used in status epilepticus 47 0.49 0.79 0.17 -1.76
    Amorolfine hydrochloride 0 Antifungal preparations 337 0.00 0.10 0.06 -1.75
      Hydrocortisone 86 Copound haemorrhoidal preparations with corticosteroid 358 0.24 0.56 0.18 -1.75