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Prototype Prescribing Outlier Dashboard for Stevenage North 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 Stevenage North PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Benzyl benzoate 1 Parasiticidal preparations 55 0.02 0.00 0.00 10.38
Glycopyrronium bromide 5 Antiperspirants 16 0.31 0.01 0.04 8.36
Betaxolol 80 Treatment of glaucoma 4,103 0.02 0.00 0.00 7.45
Bifonazole 2 Antifungal preparations 433 0.00 0.00 0.00 7.20
Cyproterone acetate 9 Male sex hormones and antagonists 2,860 0.00 0.00 0.00 6.86
Nabilone 8 Drugs used in nausea and vertigo 3,257 0.00 0.00 0.00 6.46
Benzocaine 8 Drugs for oral ulceration and inflammation 183 0.04 0.00 0.01 4.85
Nedocromil sodium 1 Other anti-inflammatory preparations 394 0.00 0.00 0.00 4.66
Other urological pain preparations 7 Drugs used in urological pain 31 0.23 0.01 0.05 4.36
Co-phenotrope (Diphenox hydrochloride/atropine sulfate) 10 Antimotility drugs 925 0.01 0.00 0.00 4.18

Prescribing where Stevenage North PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aluminium chloride 11 Antiperspirants 16 0.69 0.99 0.04 -8.14
Clotrimazole 250 Vaginal and vulval infections 333 0.75 0.90 0.05 -3.11
Cetirizine hydrochloride 547 Antihistamines 5,621 0.10 0.28 0.08 -2.33
Potassium citrate 15 Drugs used in urological pain 31 0.48 0.93 0.19 -2.31
Nicotine 12 Nicotine dependence 89 0.13 0.68 0.24 -2.23
Vitamin E 0 Vitamin E 14 0.00 0.73 0.33 -2.23
    Midazolam hydrochloride 34 Drugs used in status epilepticus 77 0.44 0.79 0.17 -2.04
    Loperamide hydrochloride 914 Antimotility drugs 925 0.99 1.00 0.00 -1.93
    Magnesium aspartate 0 Magnesium 57 0.00 0.50 0.27 -1.88
      Zinc sulfate monohydrate 2 Zinc 13 0.15 0.74 0.33 -1.79