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Prototype Prescribing Outlier Dashboard for Hh 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 Hh Collaborative PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Flutamide 31 Prostate cancer and gonadorelin analogues 301 0.10 0.00 0.00 24.87
Nimodipine 32 Calcium-channel blockers 29,234 0.00 0.00 0.00 16.10
Liquid paraffin 222 Emollient bath and shower preparations 771 0.29 0.03 0.04 6.75
Hydrogen peroxide 1 Oxidisers and dyes 1 1.00 0.06 0.19 4.99
Fluvoxamine maleate 75 Selective serotonin re-uptake inhibitors 16,110 0.00 0.00 0.00 4.94
Heparin flushes 17 Parenteral anticoagulants 57 0.30 0.03 0.06 4.64
Modafinil 167 CNS Stimulants and drugs used for ADHD 569 0.29 0.06 0.05 4.56
Flavoxate hydrochloride 54 Drugs for urinary frequency enuresis and incontinence 4,765 0.01 0.00 0.00 3.42
Dibrompropamidine isetionate 5 Preparations for minor cuts and abrasions 20 0.25 0.01 0.07 3.23
Co-dydramol (Dihydrocodeine/paracetamol) 2,285 Non-opioid analgesics and compound preparations 13,557 0.17 0.05 0.04 3.21

Prescribing where Hh Collaborative PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium permanganate 0 Oxidisers and dyes 1 0.00 0.94 0.19 -4.96
    Flecainide acetate 72 Drugs for arrhythmias 605 0.12 0.46 0.15 -2.27
    Gabapentin 1,887 Control of epilepsy 17,671 0.11 0.23 0.06 -2.09
    Rifampicin 6 Antituberculosis drugs 70 0.09 0.74 0.34 -1.91
    Naftidrofuryl oxalate 15 Peripheral vasodilators and related drugs 93 0.16 0.67 0.28 -1.86
    Fluorouracil (Sunscreen) 4 Sunscreening preparations 68 0.06 0.46 0.22 -1.79
    Amantadine hydrochloride 0 Dopaminergic drugs used in parkinsonism 1,877 0.00 0.03 0.02 -1.78
      Colecalciferol 19,764 Vitamin D 21,001 0.94 0.97 0.01 -1.72
      Naratriptan hydrochloride 2 Treatment of acute migraine 964 0.00 0.04 0.02 -1.64
      Methylphenidate hydrochloride 276 CNS Stimulants and drugs used for ADHD 569 0.49 0.65 0.11 -1.58