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Prototype Prescribing Outlier Dashboard for Watling Street Network 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 Watling Street Network PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dydrogesterone 1 Progestogens and progesterone receptor modulators 457 0.00 0.00 0.00 35.41
Calcium lactate 2 Calcium supplements 99 0.02 0.00 0.00 21.62
Clofazimine 4 Antileprotic drugs 9 0.44 0.00 0.02 20.85
Other topical nasal decongestant preparations 3 Topical nasal decongestants 52 0.06 0.00 0.00 16.91
Nystatin 3 Vaginal and vulval infections 229 0.01 0.00 0.00 12.32
Co-phenotrope (Diphenox hydrochloride/atropine sulfate) 10 Antimotility drugs 327 0.03 0.00 0.00 12.21
Azilsartan medoxomil 8 Angiotensin-II receptor antagonists 6,175 0.00 0.00 0.00 7.68
Gluten free/low protein bread 42 Foods for special diets 320 0.13 0.01 0.02 7.57
Lidocaine 11 Topical local anaesthetics and antipruritics 29 0.38 0.07 0.06 4.76
Hydroxocobalamin 2,328 Drugs used in megaloblastic anaemias 3,810 0.61 0.19 0.09 4.50

Prescribing where Watling Street Network PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dapsone 5 Antileprotic drugs 9 0.56 1.00 0.02 -20.85
Loperamide hydrochloride 316 Antimotility drugs 327 0.97 1.00 0.00 -6.41
Allopurinol 1,365 Gout and cytotoxic induced hyperiuicaemia 1,723 0.79 0.90 0.03 -4.04
Acamprosate calcium 0 Alcohol dependence 9 0.00 0.83 0.23 -3.54
    Urea hydrogen peroxide 2 Removal of ear wax and other substances 28 0.07 0.84 0.24 -3.25
    Folic acid 1,193 Drugs used in megaloblastic anaemias 3,810 0.31 0.68 0.13 -2.74
    Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 31 0.00 0.67 0.28 -2.44
      Alfentanil hydrochloride 0 Opioid analgesics 1 0.00 0.84 0.35 -2.36
        Pizotifen malate 57 Prophylaxis of migraine 174 0.33 0.63 0.13 -2.31
        Filgrastim 0 Drugs used in neutropenia 6 0.00 0.84 0.37 -2.24