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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenylbutazone 7 Non-steroidal anti-inflammatory drugs 4,743 0.00 0.00 0.00 15.30
Paracetamol and ibuprofen 9 Non-opioid analgesics and compound preparations 14,806 0.00 0.00 0.00 13.55
Indoramin 1 Alpha-adrenoceptor blocking drugs 2,327 0.00 0.00 0.00 9.72
Squill 1 Expectorant and demulcent cough preparations 9 0.11 0.00 0.01 9.08
Diclofenac potassium 69 Non-steroidal anti-inflammatory drugs 4,743 0.01 0.00 0.00 8.34
Methenamine hippurate 1,093 Urinary-tract infections 2,456 0.45 0.04 0.05 8.09
Bromocriptine 15 Bromocriptine and other dopaminergic drugs 17 0.88 0.10 0.13 6.07
Titanium dioxide 6 Sunscreening preparations 246 0.02 0.00 0.00 6.02
Nicotinamide 5 Topical preparations for acne 308 0.02 0.00 0.00 5.38
Evolocumab 2 Lipid-regulating drugs 32,308 0.00 0.00 0.00 4.74

Prescribing where West Somerset PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nitrofurantoin 1,363 Urinary-tract infections 2,456 0.55 0.96 0.05 -8.09
Phenoxymethylpenicillin (Penicillin V) 536 Benzylpenicillin and phenoxymethylpenicillin 537 1.00 1.00 0.00 -4.58
Cabergoline 2 Bromocriptine and other dopaminergic drugs 17 0.12 0.85 0.16 -4.54
Permethrin 24 Parasiticidal preparations 57 0.42 0.84 0.11 -3.75
Trimethoprim 299 Sulfonamides and trimethoprim 471 0.63 0.87 0.07 -3.53
Mercaptopurine 15 Antimetabolites 271 0.06 0.81 0.27 -2.76
Neomycin sulfate 126 Nasal preparations for infection 195 0.65 0.83 0.07 -2.71
Procyclidine hydrochloride 242 Antimuscarinic drugs used in parkinsonism 422 0.57 0.85 0.11 -2.58
Salicylic acid 4 Preparations for warts and calluses 33 0.12 0.65 0.22 -2.44
Insulin aspart 544 Short-acting insulins 891 0.61 0.79 0.09 -2.12