Skip to main content

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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lamivudine/tenofovir disoproxil/doravirine 1 HIV infection 6 0.17 0.00 0.01 20.00
Methyl salicylate/levomenthol 12 Rubefacients, topical NSAIDS, capsaicin and poultice 3,212 0.00 0.00 0.00 10.25
Ephedrine hydrochloride 3 Topical nasal decongestants 44 0.07 0.00 0.01 7.11
Ketotifen fumarate 48 Antihistamines 5,657 0.01 0.00 0.00 6.75
Aminophylline hydrate 160 Theophylline 284 0.56 0.07 0.08 5.78
Methylcellulose 4 Bulk-forming laxatives 207 0.02 0.00 0.00 5.26
Trandolapril 124 Angiotensin-converting enzyme inhibitors 12,412 0.01 0.00 0.00 4.74
Diphenhydramine hydrochloride 1 Expectorant and demulcent cough preparations 44 0.02 0.00 0.01 4.41
Nepafenac 51 Ocular diagnostic & peri-operative prepn & photodynamic tt 60 0.85 0.13 0.16 4.41
Alverine citrate/simeticone 3 Antispasmodic and other drugs altering gut motility 1,000 0.00 0.00 0.00 4.24

Prescribing where Neohealth PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Theophylline 124 Theophylline 284 0.44 0.93 0.08 -5.78
Nicorandil 39 Other antianginal drugs 513 0.08 0.51 0.14 -3.11
Water for injection 12 Electrolytes and water 34 0.35 0.82 0.16 -2.94
Simvastatin 2,136 Lipid-regulating drugs 29,377 0.07 0.22 0.05 -2.83
Aciclovir 340 Herpes simplex and varicella-zoster 400 0.85 0.95 0.04 -2.78
Bendroflumethiazide 1,332 Thiazides and related diuretics 4,307 0.31 0.57 0.10 -2.60
Hydroxycarbamide 5 Other antineoplastic drugs 6 0.83 0.99 0.06 -2.55
Brinzolamide 83 Treatment of glaucoma 1,948 0.04 0.10 0.03 -1.97
Gabapentin 1,310 Control of epilepsy 11,475 0.11 0.23 0.06 -1.97
Carbimazole 292 Antithyroid drugs 342 0.85 0.93 0.04 -1.84