Skip to main content

Prototype Prescribing Outlier Dashboard for The Crays Collaborative 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 Crays Collaborative PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dipipanone hydrochloride 30 Opioid analgesics 6,664 0.00 0.00 0.00 14.24
Ambrisentan 1 Vasodilator antihypertensive drugs 120 0.01 0.00 0.00 11.92
Lithium citrate 30 Drugs used for mania and hypomania 367 0.08 0.01 0.01 7.60
Cefuroxime axetil 14 Cephalosporins 186 0.08 0.00 0.01 7.23
Hydrogen peroxide 4 Mouth-washes, gargles and dentifrices 26 0.15 0.01 0.03 5.56
Amisulpride 371 Antipsychotic drugs 2,867 0.13 0.03 0.02 4.72
Levomepromazine maleate 57 Antipsychotic drugs 2,867 0.02 0.00 0.00 4.36
Paraldehyde 11 Drugs used in status epilepticus 39 0.28 0.02 0.06 4.30
Alprostadil 77 Drugs for erectile dysfunction 1,144 0.07 0.02 0.01 4.14
Aluminium and magnesium and oxetacaine 7 Antacids and simeticone 20 0.35 0.03 0.08 3.94

Prescribing where The Crays Collaborative PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine gluconate 22 Mouth-washes, gargles and dentifrices 26 0.85 0.98 0.05 -2.87
Water for injection 8 Electrolytes and water 21 0.38 0.82 0.16 -2.76
Terbinafine hydrochloride 62 Other antifungals 65 0.95 0.99 0.02 -2.43
Spironolactone 665 Potassium-sparing diuretics and aldosterone antagonists 1,220 0.55 0.72 0.10 -1.81
Risperidone 217 Antipsychotic drugs 2,867 0.08 0.15 0.04 -1.81
Zinc sulfate monohydrate 35 Zinc 213 0.16 0.74 0.33 -1.76
Carbomer 940/980 69 Tear deficiency, eye lubricant/astringent 464 0.15 0.34 0.11 -1.75
Sertraline hydrochloride 3,947 Selective serotonin re-uptake inhibitors 10,903 0.36 0.46 0.06 -1.75
Carbamazepine 412 Control of epilepsy 9,179 0.04 0.07 0.02 -1.73
Ivabradine 46 Other antianginal drugs 648 0.07 0.24 0.10 -1.62