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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lidocaine hydrochloride 8 Topical local anaesthetics and antipruritics 159 0.05 0.00 0.00 48.77
Co-flumactone (Hydroflumethiazide/spironolactone) 65 Potassium sparing diuretics and compounds 547 0.12 0.00 0.01 12.71
Enzalutamide 3 Prostate cancer and gonadorelin analogues 427 0.01 0.00 0.00 8.08
Sucralfate 8 Soothing haemorrhoidal preparations 69 0.12 0.00 0.01 7.63
Sulfadiazine 8 Sulfonamides and trimethoprim 1,028 0.01 0.00 0.00 7.35
Gentamicin sulfate 1 Antibacterial preparations also used systemically 416 0.00 0.00 0.00 7.14
Hydrocortisone butyrate 101 Topical corticosteroids 3,983 0.03 0.00 0.00 6.35
Diclofenac sodium 1,472 Non-steroidal anti-inflammatory drugs 9,778 0.15 0.04 0.02 5.90
Clonazepam 3,082 Control of epilepsy 25,026 0.12 0.03 0.02 5.85
Low protein miscellaneous 6 Foods for special diets 710 0.01 0.00 0.00 5.49

Prescribing where Clacton PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium cromoglicate 2 Cromoglycate and related therapy 4 0.50 0.98 0.13 -3.65
Sumatriptan succinate 970 Treatment of acute migraine 2,004 0.48 0.66 0.06 -2.69
Codeine phosphate 15 Cough suppressants 55 0.27 0.77 0.20 -2.50
Macrogol 3350 3,288 Osmotic laxatives 5,819 0.57 0.72 0.07 -2.19
Naproxen 5,512 Non-steroidal anti-inflammatory drugs 9,778 0.56 0.69 0.06 -2.02
Oxybutynin 339 Drugs for urinary frequency enuresis and incontinence 4,818 0.07 0.18 0.05 -1.93
Other emollient preparations 1,712 Emollients 2,103 0.81 0.89 0.04 -1.78
Cyclizine hydrochloride 425 Drugs used in nausea and vertigo 4,464 0.10 0.17 0.04 -1.74
Clopidogrel 5,679 Antiplatelet drugs 22,493 0.25 0.33 0.04 -1.72
Cocois 13 Preparations for psoriasis 627 0.02 0.06 0.03 -1.70