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Prototype Prescribing Outlier Dashboard for South Worcs Worcester City Gp 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 South Worcs Worcester City Gp PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine acetate 2 Chlorhexidine salts 141 0.01 0.00 0.00 11.50
Choriogonadotropin alfa 4 Hypothalamic & anterior pituitary hormone & antioestrogens 31 0.13 0.00 0.02 5.71
Ramipril with calcium channel blocker 64 Angiotensin-converting enzyme inhibitors 46,219 0.00 0.00 0.00 3.97
Low protein miscellaneous 8 Foods for special diets 1,309 0.01 0.00 0.00 3.90
Alimemazine tartrate 101 Antihistamines 10,185 0.01 0.00 0.00 3.69
Low protein cakes 24 Foods for special diets 1,309 0.02 0.00 0.00 3.65
Insulin human 5 Short-acting insulins 3,781 0.00 0.00 0.00 3.57
Fluphenazine decanoate 8 Antipsychotic depot injections 121 0.07 0.00 0.02 3.52
Naldemedine 22 Peripheral opioid-receptor antagonists 50 0.44 0.03 0.12 3.43
Gluten free/low protein pasta 60 Foods for special diets 1,309 0.05 0.01 0.01 3.21

Prescribing where South Worcs Worcester City Gp PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine gluconate 139 Chlorhexidine salts 141 0.99 1.00 0.00 -11.50
Naloxegol 28 Peripheral opioid-receptor antagonists 50 0.56 0.97 0.13 -3.13
Erythromycin 13 Topical preparations for acne 1,483 0.01 0.12 0.05 -2.12
Glycopyrronium bromide 7 Antimuscarinic drugs 88 0.08 0.78 0.36 -1.92
Amlodipine 25,882 Calcium-channel blockers 43,621 0.59 0.75 0.08 -1.90
Eplerenone 328 Potassium-sparing diuretics and aldosterone antagonists 4,341 0.08 0.25 0.10 -1.81
Linagliptin 394 Other antidiabetic drugs 13,426 0.03 0.16 0.07 -1.80
Salicylic acid 29 Preparations for warts and calluses 106 0.27 0.65 0.22 -1.74
Letrozole 301 Breast cancer 2,287 0.13 0.44 0.18 -1.71
Medroxyprogesterone acetate 0 Progestogens 1 0.00 0.65 0.41 -1.59