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Prototype Prescribing Outlier Dashboard for Greenwich West 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 Greenwich West PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lactic acid 2 Emollients 1,041 0.00 0.00 0.00 39.95
Enalapril maleate with diuretic 28 Angiotensin-converting enzyme inhibitors 7,589 0.00 0.00 0.00 8.37
Belladonna alkaloids 20 Antispasmodic and other drugs altering gut motility 593 0.03 0.00 0.00 8.20
Propamidine isetionate 6 Antibacterials 388 0.02 0.00 0.00 7.30
Proguanil hydrochloride with atovaquone 4 Antimalarials 495 0.01 0.00 0.00 6.73
Glycopyrronium bromide 4 Antiperspirants 16 0.25 0.01 0.04 6.65
Hexetidine 6 Mouth-washes, gargles and dentifrices 37 0.16 0.01 0.02 6.38
Moxifloxacin hydrochloride 13 Ocular diagnostic & peri-operative prepn & photodynamic tt 36 0.36 0.02 0.06 5.89
Neomycin sulfate 1 Aminoglycosides 1 1.00 0.04 0.18 5.27
Tetracaine 41 Local anaesthetics 217 0.19 0.02 0.03 4.91

Prescribing where Greenwich West PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aluminium chloride 12 Antiperspirants 16 0.75 0.99 0.04 -6.47
Chlorhexidine gluconate 30 Mouth-washes, gargles and dentifrices 37 0.81 0.98 0.05 -3.65
Terbinafine hydrochloride 90 Other antifungals 95 0.95 0.99 0.02 -2.84
Topiramate 77 Control of epilepsy 6,969 0.01 0.04 0.01 -2.43
Bendroflumethiazide 507 Thiazides and related diuretics 1,468 0.35 0.57 0.10 -2.24
Finasteride 371 Male sex hormones and antagonists 559 0.66 0.83 0.07 -2.24
Lidocaine hydrochloride 164 Local anaesthetics 217 0.76 0.91 0.07 -2.24
Tiotropium bromide 264 Antimuscarinic bronchodilators 671 0.39 0.71 0.14 -2.18
Rifampicin 0 Antituberculosis drugs 7 0.00 0.74 0.34 -2.17
    Colecalciferol 5,228 Vitamin D 5,580 0.94 0.97 0.01 -2.01