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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Orphenadrine hydrochloride 59 Antimuscarinic drugs used in parkinsonism 370 0.16 0.01 0.02 9.35
Other vitamin A preparations 0906011 1 Vitamin A 1 1.00 0.03 0.14 7.02
Isotretinoin 143 Oral preparations for acne 165 0.87 0.03 0.12 6.91
Aminophylline 1 Theophylline 93 0.01 0.00 0.00 5.81
Metformin hydrochloride/pioglitazone 36 Other antidiabetic drugs 2,909 0.01 0.00 0.00 4.72
Methenamine hippurate 577 Urinary-tract infections 2,114 0.27 0.04 0.05 4.67
Aclidinium bromide 422 Antimuscarinic bronchodilators 1,742 0.24 0.04 0.05 4.26
Bempedoic acid 24 Lipid-regulating drugs 39,012 0.00 0.00 0.00 4.22
Alirocumab 3 Lipid-regulating drugs 39,012 0.00 0.00 0.00 3.82
Linaclotide 21 Other drugs used in constipation 22 0.95 0.27 0.19 3.71

Prescribing where Kendal PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-cyprindiol (Cyprote acetate/ethinylestradiol) 22 Oral preparations for acne 165 0.13 0.97 0.12 -6.91
Nitrofurantoin 1,537 Urinary-tract infections 2,114 0.73 0.96 0.05 -4.67
Prucalopride 1 Other drugs used in constipation 22 0.05 0.73 0.19 -3.71
Atropine sulfate 0 Mydriatics and cycloplegics 7 0.00 0.75 0.22 -3.46
    Famotidine 85 H2-Receptor antagonists 166 0.51 0.83 0.11 -2.78
    Vitamin A 0 Vitamin A 1 0.00 0.82 0.32 -2.58
      Methylprednisolone acetate 3 Local corticosteroid injections 300 0.01 0.73 0.29 -2.48
      Mercaptopurine 29 Antimetabolites 214 0.14 0.81 0.27 -2.47
      Trimethoprim 293 Sulfonamides and trimethoprim 406 0.72 0.87 0.07 -2.23
      Light liquid paraffin 4 Emollient bath and shower preparations 78 0.05 0.33 0.13 -2.22