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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydrochlorothiazide 11 Thiazides and related diuretics 5,219 0.00 0.00 0.00 5.09
Escitalopram 2,386 Selective serotonin re-uptake inhibitors 17,399 0.14 0.04 0.02 4.78
Oxazepam 198 Anxiolytics 2,619 0.08 0.01 0.01 4.39
Tafluprost and timolol 120 Treatment of glaucoma 4,606 0.03 0.00 0.01 4.23
Levomepromazine hydrochloride 157 Antipsychotic drugs 2,769 0.06 0.01 0.01 3.68
Loperamide hydrochloride and simeticone 9 Antimotility drugs 654 0.01 0.00 0.00 3.62
Aluminium and magnesium and activated simeticone 9 Antacids and simeticone 11 0.82 0.16 0.20 3.35
Isotretinoin 28 Oral preparations for acne 66 0.42 0.03 0.12 3.24
Telmisartan with diuretic 70 Angiotensin-II receptor antagonists 9,173 0.01 0.00 0.00 2.94
Doxepin hydrochloride 15 Topical local anaesthetics and antipruritics 175 0.09 0.01 0.03 2.74

Prescribing where Whitstable PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-cyprindiol (Cyprote acetate/ethinylestradiol) 38 Oral preparations for acne 66 0.58 0.97 0.12 -3.24
Loperamide hydrochloride 643 Antimotility drugs 654 0.98 1.00 0.00 -2.95
Furosemide 3,259 Loop diuretics 4,933 0.66 0.85 0.07 -2.69
Methylprednisolone acetate 106 Local corticosteroid injections 972 0.11 0.73 0.29 -2.14
Cetirizine hydrochloride 503 Antihistamines 4,440 0.11 0.28 0.08 -2.13
Other emollient preparations 1,628 Emollients 2,029 0.80 0.89 0.04 -2.05
Cabergoline 17 Bromocriptine and other dopaminergic drugs 31 0.55 0.85 0.16 -1.86
Isosorbide mononitrate 839 Nitrates 1,380 0.61 0.73 0.07 -1.78
Baclofen 423 Skeletal muscle relaxants 699 0.61 0.81 0.12 -1.76
Amlodipine 11,199 Calcium-channel blockers 18,169 0.62 0.75 0.08 -1.62