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Prototype Prescribing Outlier Dashboard for Sedgefield 1 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 Sedgefield 1 PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Japanese encephalitis vaccine (Inactivated,adsorbed) 1 Vaccines and antisera 12,998 0.00 0.00 0.00 35.41
Pyrimethamine 8 Antimalarials 1,650 0.00 0.00 0.00 8.88
Sucralfate 7 Soothing haemorrhoidal preparations 62 0.11 0.00 0.01 7.43
Fosfomycin calcium 2 Urinary-tract infections 2,646 0.00 0.00 0.00 7.07
Aprepitant 14 Drugs used in nausea and vertigo 4,992 0.00 0.00 0.00 6.57
Nystatin 3 Vaginal and vulval infections 533 0.01 0.00 0.00 5.18
Aminosalicylic acid 1 Antituberculosis drugs 4 0.25 0.00 0.05 5.16
Ciprofloxacin 181 Antibacterials 681 0.27 0.05 0.04 5.07
Risperidone 29 Antipsychotic depot injections 36 0.81 0.08 0.17 4.27
Cinnarizine 751 Drugs used in nausea and vertigo 4,992 0.15 0.05 0.02 4.24

Prescribing where Sedgefield 1 PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Acamprosate calcium 0 Alcohol dependence 5 0.00 0.83 0.23 -3.54
    Gliclazide 2,407 Sulfonylureas 3,858 0.62 0.93 0.11 -2.74
    Nicotine 4 Nicotine dependence 68 0.06 0.68 0.24 -2.55
    Nitrofurantoin 2,213 Urinary-tract infections 2,646 0.84 0.96 0.05 -2.50
    Estradiol 415 Oestrogens and Hormone Replacement Therapy 1,416 0.29 0.49 0.09 -2.17
    Co-careldopa (Carbidopa/levodopa) 134 Dopaminergic drugs used in parkinsonism 2,460 0.05 0.32 0.12 -2.17
    Citalopram hydrobromide 6,876 Selective serotonin re-uptake inhibitors 33,668 0.20 0.32 0.05 -2.13
    Amitriptyline hydrochloride 13,041 Tricyclic and related antidepressant drugs 17,879 0.73 0.84 0.05 -2.08
    Clobetasone butyrate 385 Topical corticosteroids 5,355 0.07 0.13 0.03 -1.95
    Chloramphenicol 465 Antibacterials 681 0.68 0.80 0.06 -1.93