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Prototype Prescribing Outlier Dashboard for Selsdon Addington & Shirley 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 Selsdon Addington & Shirley PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Meningococcal A + C + W135 + Y vaccine 29 Vaccines and antisera 7,481 0.00 0.00 0.00 11.62
Fosinopril sodium 32 Angiotensin-converting enzyme inhibitors 11,531 0.00 0.00 0.00 10.60
Heparinoid 293 Rubefacients, topical NSAIDS, capsaicin and poultice 1,242 0.24 0.03 0.02 8.79
Torasemide 58 Loop diuretics 3,650 0.02 0.00 0.00 6.43
Glutaraldehyde 7 Preparations for warts and calluses 43 0.16 0.01 0.03 5.50
Paliperidone 7 Antipsychotic depot injections 10 0.70 0.07 0.14 4.47
Rufinamide 31 Control of epilepsy 7,152 0.00 0.00 0.00 4.47
Norethisterone 129 Oral progestogen-only contraceptives 815 0.16 0.05 0.02 4.34
Diethylamine salicylate 221 Rubefacients, topical NSAIDS, capsaicin and poultice 1,242 0.18 0.02 0.04 3.90
Prochlorperazine maleate 461 Drugs used in nausea and vertigo 1,139 0.40 0.25 0.05 3.51

Prescribing where Selsdon Addington & Shirley PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Desogestrel 674 Oral progestogen-only contraceptives 815 0.83 0.94 0.03 -3.97
Carbimazole 241 Antithyroid drugs 306 0.79 0.93 0.04 -3.36
Pizotifen malate 65 Prophylaxis of migraine 277 0.23 0.63 0.13 -3.02
Ibuprofen 198 Rubefacients, topical NSAIDS, capsaicin and poultice 1,242 0.16 0.52 0.16 -2.27
Losartan potassium 915 Angiotensin-II receptor antagonists 6,204 0.15 0.50 0.16 -2.26
Vitamin E 0 Vitamin E 2 0.00 0.73 0.33 -2.23
    Methotrexate 384 Rheumatic disease suppressant drugs 1,119 0.34 0.58 0.11 -2.20
    Vitamin A 1 Vitamin A 5 0.20 0.82 0.32 -1.95
    Quetiapine 370 Antipsychotic drugs 1,852 0.20 0.36 0.08 -1.92
    Colecalciferol 5,704 Vitamin D 6,073 0.94 0.97 0.01 -1.85