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Prototype Prescribing Outlier Dashboard for Crawley Care 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 Crawley Care Collaborative PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Clomipramine hydrochloride 300 Tricyclic and related antidepressant drugs 5,623 0.05 0.01 0.01 5.27
Co-phenotrope (Diphenox hydrochloride/atropine sulfate) 7 Antimotility drugs 581 0.01 0.00 0.00 4.68
Olmesartan medoxomil/hydrochlorothiazide 67 Angiotensin-II receptor antagonists 10,718 0.01 0.00 0.00 4.57
Tropicamide 8 Mydriatics and cycloplegics 32 0.25 0.02 0.06 3.56
Testosterone enantate 11 Male sex hormones and antagonists 1,011 0.01 0.00 0.00 3.55
Testosterone 191 Male sex hormones and antagonists 1,011 0.19 0.07 0.04 3.29
Trimipramine maleate 49 Tricyclic and related antidepressant drugs 5,623 0.01 0.00 0.00 3.29
Estradiol valerate 148 Oestrogens and Hormone Replacement Therapy 1,709 0.09 0.03 0.02 3.22
Linagliptin 3,495 Other antidiabetic drugs 9,217 0.38 0.16 0.07 2.92
Paracetamol combined preparations 16 Non-opioid analgesics and compound preparations 12,600 0.00 0.00 0.00 2.91

Prescribing where Crawley Care Collaborative PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Finasteride 602 Male sex hormones and antagonists 1,011 0.60 0.83 0.07 -3.18
Quinine sulfate 831 Antimalarials 1,155 0.72 0.90 0.08 -2.34
Flecainide acetate 40 Drugs for arrhythmias 280 0.14 0.46 0.15 -2.11
Prucalopride 7 Other drugs used in constipation 19 0.37 0.73 0.19 -1.97
Loperamide hydrochloride 574 Antimotility drugs 581 0.99 1.00 0.00 -1.97
Glucagon 14 Treatment of hypoglycaemia 216 0.06 0.23 0.08 -1.94
Oxybutynin 236 Drugs for urinary frequency enuresis and incontinence 3,216 0.07 0.18 0.05 -1.88
Sulfasalazine 140 Aminosalicylates 849 0.16 0.33 0.09 -1.83
Gentamicin sulfate 0 Aminoglycosides 4 0.00 0.74 0.41 -1.80
    Gabapentin 1,639 Control of epilepsy 12,739 0.13 0.23 0.06 -1.73