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Prototype Prescribing Outlier Dashboard for South Rural 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 South Rural PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Olmesartan medoxomil/amlodipine 378 Angiotensin-II receptor antagonists 17,982 0.02 0.00 0.00 11.17
Timolol with diuretic 7 Beta-adrenoceptor blocking drugs 33,630 0.00 0.00 0.00 11.04
Aceclofenac 67 Non-steroidal anti-inflammatory drugs 6,364 0.01 0.00 0.00 8.23
Perindopril arginine with diuretic 368 Angiotensin-converting enzyme inhibitors 36,264 0.01 0.00 0.00 7.80
Hydrocort sodiumphos 98 Antibacterials 887 0.11 0.01 0.02 6.01
Mebeverine hydrochloride compound preparations 220 Antispasmodic and other drugs altering gut motility 3,344 0.07 0.01 0.01 5.23
Etodolac 320 Non-steroidal anti-inflammatory drugs 6,364 0.05 0.01 0.01 3.75
Silver nitrate 16 Preparations for warts and calluses 42 0.38 0.07 0.08 3.70
Acebutolol hydrochloride 47 Beta-adrenoceptor blocking drugs 33,630 0.00 0.00 0.00 3.63
Doxycycline monohydrate 33 Tetracyclines 2,333 0.01 0.00 0.00 3.30

Prescribing where South Rural PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Doxycycline hyclate 1,048 Tetracyclines 2,333 0.45 0.70 0.08 -2.94
Tiotropium bromide 561 Antimuscarinic bronchodilators 1,741 0.32 0.71 0.14 -2.67
Amlodipine 23,488 Calcium-channel blockers 40,309 0.58 0.75 0.08 -2.03
Zinc oxide 34 Barrier preparations 448 0.08 0.51 0.23 -1.90
Estriol 523 Preparations for vaginal/vulval changes 3,245 0.16 0.44 0.15 -1.89
Tramadol hydrochloride 2,176 Opioid analgesics 14,128 0.15 0.26 0.06 -1.84
Clotrimazole 295 Vaginal and vulval infections 363 0.81 0.90 0.05 -1.83
Donepezil hydrochloride 724 Drugs for dementia 2,511 0.29 0.48 0.11 -1.76
Chlorphenamine maleate 209 Antihistamines 9,036 0.02 0.06 0.02 -1.76
Other emollient preparations 1,564 Emollients 1,914 0.82 0.89 0.04 -1.71