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Prototype Prescribing Outlier Dashboard for Freshney Pelham Nel 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 Freshney Pelham Nel PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pitolisant hydrochloride 6 CNS Stimulants and drugs used for ADHD 259 0.02 0.00 0.00 14.51
Tetracycline 70 Tetracyclines 1,277 0.05 0.01 0.00 10.74
Methyl salicylate 65 Rubefacients, topical NSAIDS, capsaicin and poultice 1,479 0.04 0.00 0.01 7.56
Hamamelis 5 Soothing haemorrhoidal preparations 41 0.12 0.00 0.02 6.55
Salmeterol 622 Selective beta(2)-agonists 12,649 0.05 0.01 0.01 6.07
Ipratropium bromide 416 Antimuscarinic bronchodilators 1,707 0.24 0.07 0.03 5.27
Levonorgestrel 62 Oral progestogen-only contraceptives 1,166 0.05 0.01 0.01 5.13
Tolfenamic acid 18 Treatment of acute migraine 1,111 0.02 0.00 0.00 5.08
Benzoyl peroxide 84 Topical preparations for acne 327 0.26 0.08 0.04 4.43
Ofloxacin 48 Antibacterials 461 0.10 0.01 0.02 4.33

Prescribing where Freshney Pelham Nel PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Moxonidine 29 Centrally-acting antihypertensive drugs 330 0.09 0.69 0.19 -3.08
Macrogol 3350 2,320 Osmotic laxatives 4,219 0.55 0.72 0.07 -2.41
Sertraline hydrochloride 5,753 Selective serotonin re-uptake inhibitors 16,956 0.34 0.46 0.06 -2.16
Zinc oxide 22 Barrier preparations 502 0.04 0.51 0.23 -2.05
Ganciclovir 0 Antivirals 1 0.00 0.65 0.33 -2.00
    Tadalafil 145 Drugs for erectile dysfunction 1,541 0.09 0.19 0.05 -1.98
    Esomeprazole 58 Proton pump inhibitors 30,321 0.00 0.03 0.02 -1.97
    Adapalene and benzoyl peroxide 14 Topical preparations for acne 327 0.04 0.17 0.07 -1.94
    Famotidine 108 H2-Receptor antagonists 178 0.61 0.83 0.11 -1.94
    Chlorhexidine gluconate 24 Mouth-washes, gargles and dentifrices 27 0.89 0.98 0.05 -1.92