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Prototype Prescribing Outlier Dashboard for North Lincolnshire South 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 North Lincolnshire South PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sulfur 2 Topical preparations for acne 879 0.00 0.00 0.00 6.13
Alitretinoin 1 Preparations for eczema 1 1.00 0.03 0.17 5.79
Probenecid 14 Gout and cytotoxic induced hyperiuicaemia 6,937 0.00 0.00 0.00 5.04
Ofloxacin 95 Antibacterials 801 0.12 0.01 0.02 5.02
Frovatriptan 282 Treatment of acute migraine 2,981 0.09 0.02 0.02 4.96
Fusidic acid 1 Some other antibacterials 43 0.02 0.00 0.01 4.44
Isotretinoin 43 Oral preparations for acne 83 0.52 0.03 0.12 4.02
Tibolone 392 Oestrogens and Hormone Replacement Therapy 2,706 0.14 0.04 0.03 3.91
Biphasic insulin aspart 1,956 Intermediate and long-acting insulins 4,801 0.41 0.14 0.07 3.89
Fluoxetine hydrochloride 12,264 Selective serotonin re-uptake inhibitors 46,114 0.27 0.16 0.03 3.47

Prescribing where North Lincolnshire South PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-cyprindiol (Cyprote acetate/ethinylestradiol) 40 Oral preparations for acne 83 0.48 0.97 0.12 -4.02
Gamolenic acid 0 Preparations for eczema 1 0.00 0.90 0.28 -3.18
    Neomycin sulfate 175 Nasal preparations for infection 252 0.69 0.83 0.07 -2.01
    Adapalene and benzoyl peroxide 40 Topical preparations for acne 879 0.05 0.17 0.07 -1.90
    Prednisolone 62 Copound haemorrhoidal preparations with corticosteroid 557 0.11 0.44 0.18 -1.77
    Melatonin 150 Hypnotics 5,932 0.03 0.18 0.09 -1.75
    Lisdexamfetamine dimesylate 10 CNS Stimulants and drugs used for ADHD 512 0.02 0.15 0.08 -1.75
    Sertraline hydrochloride 16,709 Selective serotonin re-uptake inhibitors 46,114 0.36 0.46 0.06 -1.74
    Ulipristal acetate (Emergency Contraceptive) 6 Emergency contraception 45 0.13 0.40 0.16 -1.70
    Tacrolimus 104 Drugs affecting the immune response 165 0.63 0.80 0.11 -1.62