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Prototype Prescribing Outlier Dashboard for Well Street Common 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 Well Street Common PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Meningococcal A + C + W135 + Y vaccine 20 Vaccines and antisera 2,227 0.01 0.00 0.00 27.17
Penicillamine 40 Rheumatic disease suppressant drugs 569 0.07 0.00 0.00 14.29
Tolbutamide 227 Sulfonylureas 2,355 0.10 0.00 0.01 10.38
Repaglinide 216 Other antidiabetic drugs 2,853 0.08 0.00 0.01 10.21
Soluble insulin (Neutral insulin) 204 Short-acting insulins 1,174 0.17 0.01 0.02 9.83
Sodium polystyrene sulfonate 4 Oral potassium 31 0.13 0.00 0.01 9.36
Adalimumab 1 Rheumatic disease suppressant drugs 569 0.00 0.00 0.00 7.51
Other magnesium preparations 8 Magnesium 27 0.30 0.01 0.05 5.62
Emulsifying wax 267 Emollients 2,199 0.12 0.01 0.02 5.56
Oxcarbazepine 159 Control of epilepsy 6,595 0.02 0.00 0.00 5.49

Prescribing where Well Street Common PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenoxymethylpenicillin (Penicillin V) 543 Benzylpenicillin and phenoxymethylpenicillin 544 1.00 1.00 0.00 -4.52
Terbinafine hydrochloride 95 Other antifungals 103 0.92 0.99 0.02 -4.40
Allopurinol 753 Gout and cytotoxic induced hyperiuicaemia 922 0.82 0.90 0.03 -3.11
Carbimazole 252 Antithyroid drugs 311 0.81 0.93 0.04 -2.84
Cabergoline 9 Bromocriptine and other dopaminergic drugs 23 0.39 0.85 0.16 -2.84
Simvastatin 1,283 Lipid-regulating drugs 16,402 0.08 0.22 0.05 -2.72
Memantine hydrochloride 76 Drugs for dementia 756 0.10 0.38 0.11 -2.48
Famotidine 83 H2-Receptor antagonists 149 0.56 0.83 0.11 -2.38
Other food for special diet preparations 58 Foods for special diets 227 0.26 0.64 0.17 -2.27
Mebeverine hydrochloride 222 Antispasmodic and other drugs altering gut motility 718 0.31 0.45 0.07 -2.19