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Prototype Prescribing Outlier Dashboard for East Merton 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 East Merton PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dienogest 11 Progestogens and progesterone receptor modulators 267 0.04 0.00 0.00 8.18
Dequalinium chloride 7 Vaginal and vulval infections 478 0.01 0.00 0.00 5.08
Hydrogen peroxide 1 Oxidisers and dyes 1 1.00 0.06 0.19 4.99
Pimozide 32 Antipsychotic drugs 6,714 0.00 0.00 0.00 4.34
Hyoscine hydrobromide 164 Drugs used in nausea and vertigo 1,709 0.10 0.02 0.02 4.29
Hydrochlorothiazide 8 Thiazides and related diuretics 4,796 0.00 0.00 0.00 3.97
Amiloride hydrochloride 186 Potassium-sparing diuretics and aldosterone antagonists 1,866 0.10 0.03 0.02 3.40
Metolazone 39 Thiazides and related diuretics 4,796 0.01 0.00 0.00 3.38
Pentoxifylline 28 Peripheral vasodilators and related drugs 33 0.85 0.15 0.21 3.33
Phenytoin 28 Control of epilepsy 10,391 0.00 0.00 0.00 3.30

Prescribing where East Merton PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium permanganate 0 Oxidisers and dyes 1 0.00 0.94 0.19 -4.96
    Alcohol 0 Alcohols and saline 1 0.00 0.87 0.33 -2.62
      Naftidrofuryl oxalate 4 Peripheral vasodilators and related drugs 33 0.12 0.67 0.28 -2.00
      Sildenafil (Erectile Dysfunction) 1,427 Drugs for erectile dysfunction 2,162 0.66 0.76 0.05 -1.94
      Methylphenidate hydrochloride 337 CNS Stimulants and drugs used for ADHD 734 0.46 0.65 0.11 -1.83
      Coal tar 159 Shampoos and some other scalp preparations 631 0.25 0.40 0.09 -1.75
      Mebeverine hydrochloride 342 Antispasmodic and other drugs altering gut motility 1,010 0.34 0.45 0.07 -1.75
      Betahistine hydrochloride 252 Drugs used in nausea and vertigo 1,709 0.15 0.26 0.07 -1.68
      Gabapentin 1,384 Control of epilepsy 10,391 0.13 0.23 0.06 -1.65
      Pizotifen malate 45 Prophylaxis of migraine 107 0.42 0.63 0.13 -1.61