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Prototype Prescribing Outlier Dashboard for South Uttlesford 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 South Uttlesford PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Benzbromarone 9 Gout and cytotoxic induced hyperiuicaemia 4,911 0.00 0.00 0.00 7.34
Vildagliptin 145 Other antidiabetic drugs 6,295 0.02 0.00 0.00 5.43
Ketotifen fumarate 58 Antihistamines 8,758 0.01 0.00 0.00 5.14
Loperamide hydrochloride and simeticone 12 Antimotility drugs 694 0.02 0.00 0.00 4.66
Saxagliptin 558 Other antidiabetic drugs 6,295 0.09 0.01 0.02 4.60
Paliperidone 23 Antipsychotic depot injections 33 0.70 0.07 0.14 4.45
Hydrocortisone acetate 475 Topical corticosteroids 4,474 0.11 0.04 0.02 4.08
Paricalcitol 6 Vitamin D 13,577 0.00 0.00 0.00 3.72
Co-tenidone (Atenolol/chlortalidone) 270 Beta-adrenoceptor blocking drugs 23,370 0.01 0.00 0.00 3.57
Acitretin 29 Preparations for psoriasis 645 0.04 0.00 0.01 3.44

Prescribing where South Uttlesford PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Loperamide hydrochloride 678 Antimotility drugs 694 0.98 1.00 0.00 -4.23
Urea hydrogen peroxide 1 Removal of ear wax and other substances 4 0.25 0.84 0.24 -2.49
Dexamethasone 657 Otitis externa 1,068 0.62 0.78 0.07 -2.24
Amiodarone hydrochloride 119 Drugs for arrhythmias 761 0.16 0.48 0.15 -2.13
Zinc oxide 17 Barrier preparations 572 0.03 0.51 0.23 -2.11
Tacrolimus 150 Drugs affecting the immune response 256 0.59 0.80 0.11 -2.03
Procyclidine hydrochloride 162 Antimuscarinic drugs used in parkinsonism 251 0.65 0.85 0.11 -1.91
Pizotifen malate 132 Prophylaxis of migraine 342 0.39 0.63 0.13 -1.87
Ivermectin 34 Topical preparation for rosacea 49 0.69 0.89 0.11 -1.67
Cyclizine hydrochloride 286 Drugs used in nausea and vertigo 2,740 0.10 0.17 0.04 -1.53