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Prototype Prescribing Outlier Dashboard for Winchester Rural North & East 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 Winchester Rural North & East PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Alendronic acid/colecalciferol 106 Bisphosphonates and other drugs 4,407 0.02 0.00 0.00 12.92
Diclofenac sodium 119 Rubefacients, topical NSAIDS, capsaicin and poultice 2,381 0.05 0.00 0.00 9.80
Other vaginal/vulva changes preparations 1 Preparations for vaginal/vulval changes 3,237 0.00 0.00 0.00 5.88
Ins degludec/liraglutide 103 Other antidiabetic drugs 5,737 0.02 0.00 0.00 4.30
Ethosuximide 60 Control of epilepsy 9,387 0.01 0.00 0.00 4.25
Chloramphenicol 2 Some other antibacterials 230 0.01 0.00 0.00 4.17
Solifenacin/tamsulosin 181 Drugs for urinary retention 4,829 0.04 0.01 0.01 3.88
Low protein meals 24 Foods for special diets 867 0.03 0.00 0.01 3.69
Liothyronine sodium 158 Thyroid hormones 19,440 0.01 0.00 0.00 3.67
Low protein cereals 20 Foods for special diets 867 0.02 0.00 0.01 3.32

Prescribing where Winchester Rural North & East PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Levothyroxine sodium 19,274 Thyroid hormones 19,440 0.99 1.00 0.00 -3.79
Aluminium chloride 9 Antiperspirants 10 0.90 0.99 0.04 -2.47
Aciclovir 707 Herpes simplex and varicella-zoster 816 0.87 0.95 0.04 -2.33
Terbinafine hydrochloride 235 Other antifungals 244 0.96 0.99 0.02 -1.85
Coal tar 121 Shampoos and some other scalp preparations 496 0.24 0.40 0.09 -1.84
Loperamide hydrochloride 791 Antimotility drugs 800 0.99 1.00 0.00 -1.80
Alendronic acid 3,242 Bisphosphonates and other drugs 4,407 0.74 0.87 0.07 -1.79
Doxycycline hyclate 1,100 Tetracyclines 2,006 0.55 0.70 0.08 -1.76
Naproxen 2,756 Non-steroidal anti-inflammatory drugs 4,748 0.58 0.69 0.06 -1.76
Prednisolone 54 Copound haemorrhoidal preparations with corticosteroid 465 0.12 0.44 0.18 -1.75