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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Felbinac 17 Rubefacients, topical NSAIDS, capsaicin and poultice 3,704 0.00 0.00 0.00 10.09
Salicylic acid 4 Drugs for oral ulceration and inflammation 317 0.01 0.00 0.00 7.08
Pramipexole 1,104 Dopaminergic drugs used in parkinsonism 2,256 0.49 0.12 0.07 5.73
Fluocortolone 6 Copound haemorrhoidal preparations with corticosteroid 525 0.01 0.00 0.00 4.48
Bromocriptine 12 Bromocriptine and other dopaminergic drugs 18 0.67 0.10 0.13 4.39
Dithranol 13 Preparations for psoriasis 747 0.02 0.00 0.00 4.18
Fluticasone propionate (Nasal) 1,159 Drugs used in nasal allergy 3,312 0.35 0.13 0.06 3.99
Nadolol 53 Beta-adrenoceptor blocking drugs 21,918 0.00 0.00 0.00 3.76
Hydroxyzine hydrochloride 704 Antihistamines 8,621 0.08 0.03 0.02 3.58
Lidocaine hydrochloride 17 Drugs for oral ulceration and inflammation 317 0.05 0.01 0.01 3.49

Prescribing where Blackburn East PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cabergoline 6 Bromocriptine and other dopaminergic drugs 18 0.33 0.85 0.16 -3.20
Ketoconazole 185 Shampoos and some other scalp preparations 608 0.30 0.50 0.08 -2.37
Fluconazole 275 Triazole antifungals 386 0.71 0.86 0.07 -2.19
Prucalopride 51 Other drugs used in constipation 141 0.36 0.73 0.19 -2.01
Lamotrigine 1,452 Control of epilepsy 21,964 0.07 0.11 0.03 -1.86
Atropine sulfate 18 Mydriatics and cycloplegics 52 0.35 0.75 0.22 -1.86
Tamsulosin hydrochloride 2,738 Drugs for urinary retention 3,221 0.85 0.92 0.04 -1.86
Umeclidinium bromide/vilanterol 34 Compound bronchodilator preparations 545 0.06 0.50 0.25 -1.76
Sodium cromoglicate 182 Other anti-inflammatory preparations 413 0.44 0.64 0.12 -1.75
Progesterone 84 Progestogens and progesterone receptor modulators 347 0.24 0.59 0.20 -1.74