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Prototype Prescribing Outlier Dashboard for Tower Hamlets Network 2 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 Tower Hamlets Network 2 PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ulipristal acetate (Emergency Contraceptive) 3 Progestogens and progesterone receptor modulators 258 0.01 0.00 0.00 52.54
Triamcinolone acetonide 10 Drugs for oral ulceration and inflammation 296 0.03 0.00 0.00 13.77
Betamethasone sodium phosphate 72 Use of corticosteroids 1,056 0.07 0.01 0.01 12.07
Zoledronic acid 1 Bisphosphonates and other drugs 1,356 0.00 0.00 0.00 9.28
Disopyramide phosphate 10 Drugs for arrhythmias 100 0.10 0.00 0.01 8.43
Estradiol valandestradiol valerate with dienogest 10 Combined hormonal contraceptives 833 0.01 0.00 0.00 6.79
Erythromycin stearate 15 Macrolides 535 0.03 0.00 0.00 6.63
Wool alcohols 136 Emollients 3,815 0.04 0.00 0.01 6.52
Zonisamide 180 Control of epilepsy 6,893 0.03 0.01 0.00 4.69
Olmesartan medoxomil/amlodipine/hydrochlorothiazide 49 Angiotensin-II receptor antagonists 6,203 0.01 0.00 0.00 4.35

Prescribing where Tower Hamlets Network 2 PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Emollient bath and shower preparations 226 Emollient bath and shower preparations 922 0.25 0.64 0.13 -3.06
Aciclovir 228 Herpes simplex and varicella-zoster 269 0.85 0.95 0.04 -2.85
Clopidogrel 2,572 Antiplatelet drugs 11,718 0.22 0.33 0.04 -2.48
Estradiol 46 Preparations for vaginal/vulval changes 222 0.21 0.56 0.15 -2.44
Combined ethinylestradiol 30mcg 592 Combined hormonal contraceptives 833 0.71 0.81 0.04 -2.39
Prednisolone 865 Use of corticosteroids 1,056 0.82 0.89 0.03 -2.39
Zopiclone 433 Hypnotics 1,079 0.40 0.61 0.09 -2.38
Betamethasone valerate 772 Topical corticosteroids 4,279 0.18 0.28 0.04 -2.30
Desogestrel 516 Oral progestogen-only contraceptives 590 0.87 0.94 0.03 -2.24
Glucagon 1 Treatment of hypoglycaemia 25 0.04 0.23 0.08 -2.23