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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tolvaptan 10 Posterior pituitary hormones and antagonists 134 0.07 0.00 0.01 12.82
Diclofenac sodium 15 Ocular diagnostic & peri-operative prepn & photodynamic tt 31 0.48 0.03 0.07 6.81
Boric acid 1 Vaginal and vulval infections 342 0.00 0.00 0.00 6.78
Chloramphenicol 1 Some other antibacterials 85 0.01 0.00 0.00 5.67
Magnesium citrate 1 Bowel cleansing preparations 2 0.50 0.03 0.12 3.80
Shingles (H/Z) 49 Vaccines and antisera 7,388 0.01 0.00 0.00 3.70
Lacidipine 2,078 Calcium-channel blockers 27,141 0.08 0.01 0.02 3.47
Isoniazid 7 Antituberculosis drugs 7 1.00 0.15 0.28 3.00
Flurbiprofen 6 Non-steroidal anti-inflammatory drugs 3,854 0.00 0.00 0.00 2.93
Rutosides 27 Peripheral vasodilators and related drugs 68 0.40 0.06 0.12 2.85

Prescribing where Skelmersdale PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Desmopressin acetate 124 Posterior pituitary hormones and antagonists 134 0.93 1.00 0.01 -12.82
Methylphenidate hydrochloride 102 CNS Stimulants and drugs used for ADHD 243 0.42 0.65 0.11 -2.20
Rifampicin 0 Antituberculosis drugs 7 0.00 0.74 0.34 -2.17
    Prucalopride 51 Other drugs used in constipation 153 0.33 0.73 0.19 -2.16
    Combined ethinylestradiol 20mcg 74 Combined hormonal contraceptives 1,442 0.05 0.13 0.04 -1.99
    Macrogol 3350 3,122 Osmotic laxatives 5,372 0.58 0.72 0.07 -1.96
    Beclometasone dipropionate 272 Drugs used in nasal allergy 3,550 0.08 0.24 0.09 -1.75
    Dexamethasone 63 Corticosteroids 318 0.20 0.49 0.17 -1.73
    Estriol 151 Preparations for vaginal/vulval changes 817 0.18 0.44 0.15 -1.73
    Ibuprofen 162 Non-steroidal anti-inflammatory drugs 3,854 0.04 0.11 0.04 -1.72