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Prototype Prescribing Outlier Dashboard for The Wbc (Hereford City) 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 The Wbc (Hereford City) PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Temozolomide 1 Other antineoplastic drugs 56 0.02 0.00 0.00 32.33
Ertugliflozin 93 Other antidiabetic drugs 3,349 0.03 0.00 0.00 12.24
Fidaxomicin 2 Some other antibacterials 32 0.06 0.00 0.01 8.49
Apomorphine hydrochloride hemihydrate 11 Dopaminergic drugs used in parkinsonism 1,386 0.01 0.00 0.00 7.12
Benperidol 32 Antipsychotic drugs 4,339 0.01 0.00 0.00 6.62
Mexiletine hydrochloride 7 Drugs for arrhythmias 221 0.03 0.00 0.01 5.30
Eslicarbazepine acetate 83 Control of epilepsy 9,563 0.01 0.00 0.00 5.26
Vancomycin hydrochloride 7 Some other antibacterials 32 0.22 0.03 0.04 4.58
Ciclosporin 5 Tear deficiency, eye lubricant/astringent 527 0.01 0.00 0.00 4.54
Triptorelin embonate 41 Prostate cancer and gonadorelin analogues 212 0.19 0.02 0.04 3.94

Prescribing where The Wbc (Hereford City) PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ivermectin 7 Topical preparation for rosacea 13 0.54 0.89 0.11 -3.02
Benzoyl peroxide and clindamycin phosphate 42 Topical preparations for acne 262 0.16 0.37 0.07 -2.80
Calcipotriol 239 Preparations for psoriasis 315 0.76 0.87 0.04 -2.58
Allopurinol 1,334 Gout and cytotoxic induced hyperiuicaemia 1,600 0.83 0.90 0.03 -2.47
Lymecycline 53 Tetracyclines 1,173 0.05 0.24 0.08 -2.46
Dexamethasone 280 Otitis externa 455 0.62 0.78 0.07 -2.24
Pregabalin 1,392 Control of epilepsy 9,563 0.15 0.27 0.06 -2.22
Levonorgestrel 4 Emergency contraception 16 0.25 0.60 0.16 -2.18
Moxonidine 12 Centrally-acting antihypertensive drugs 40 0.30 0.69 0.19 -1.99
Senna 741 Stimulant laxatives 2,061 0.36 0.56 0.11 -1.86