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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Empagliflozin/linagliptin 92 Other antidiabetic drugs 7,283 0.01 0.00 0.00 16.54
Rufinamide 97 Control of epilepsy 10,951 0.01 0.00 0.00 9.64
Linagliptin/metformin 501 Other antidiabetic drugs 7,283 0.07 0.00 0.01 8.14
Ibuprofen sodium dihydrate 1 Non-steroidal anti-inflammatory drugs 2,685 0.00 0.00 0.00 7.69
Lidocaine hydrochloride 18 Drugs for oral ulceration and inflammation 190 0.09 0.01 0.01 6.66
Beclometasone dipropionate (Systemic) 32 Corticosteroids 66 0.48 0.03 0.08 6.00
Omega-3-acid ethyl esters 167 Lipid-regulating drugs 21,274 0.01 0.00 0.00 5.81
Ferrous gluconate 888 Oral iron 4,045 0.22 0.04 0.03 5.34
Metformin hydrochloride/pioglitazone 96 Other antidiabetic drugs 7,283 0.01 0.00 0.00 5.06
Dienogest 11 Progestogens and progesterone receptor modulators 463 0.02 0.00 0.00 4.54

Prescribing where South Crawley PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Codeine phosphate 17 Cough suppressants 73 0.23 0.77 0.20 -2.71
Baclofen 402 Skeletal muscle relaxants 785 0.51 0.81 0.12 -2.55
Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 5 0.00 0.67 0.28 -2.44
    Finasteride 483 Male sex hormones and antagonists 744 0.65 0.83 0.07 -2.44
    Ganciclovir 0 Antivirals 1 0.00 0.65 0.33 -2.00
      Beclometasone dipropionate 2,949 Corticosteroids (respiratory) 7,333 0.40 0.57 0.09 -1.82
      Benzydamine hydrochloride 136 Drugs for oral ulceration and inflammation 190 0.72 0.85 0.08 -1.77
      Tacrolimus 97 Drugs affecting the immune response 156 0.62 0.80 0.11 -1.70
      Adapalene 28 Topical preparations for acne 631 0.04 0.11 0.04 -1.61
      Ibuprofen 663 Rubefacients, topical NSAIDS, capsaicin and poultice 2,457 0.27 0.52 0.16 -1.57