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Prototype Prescribing Outlier Dashboard for Imp 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 Imp PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenindione 14 Oral anticoagulants 17,095 0.00 0.00 0.00 7.94
Ingenol mebutate 1 Sunscreening preparations 197 0.01 0.00 0.00 4.91
Other mouth wash, gargle and dentifrice preparations 7 Mouth-washes, gargles and dentifrices 74 0.09 0.00 0.02 4.13
Low protein breads 36 Foods for special diets 1,119 0.03 0.00 0.01 3.53
Povidone iodine 2 Ocular diagnostic & peri-operative prepn & photodynamic tt 116 0.02 0.00 0.00 3.52
Low protein grains/flours 15 Foods for special diets 1,119 0.01 0.00 0.00 3.40
Baricitinib 2 Rheumatic disease suppressant drugs 1,810 0.00 0.00 0.00 3.28
Travoprost 863 Treatment of glaucoma 7,406 0.12 0.03 0.03 3.19
Terazosin hydrochloride 195 Alpha-adrenoceptor blocking drugs 6,691 0.03 0.01 0.01 3.11
Low protein snacks 8 Foods for special diets 1,119 0.01 0.00 0.00 3.08

Prescribing where Imp PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ispaghula husk 547 Bulk-forming laxatives 657 0.83 0.96 0.04 -2.97
Other food for special diet preparations 349 Foods for special diets 1,119 0.31 0.64 0.17 -1.93
Doxazosin mesilate 6,495 Alpha-adrenoceptor blocking drugs 6,691 0.97 0.99 0.01 -1.86
Mirtazapine 8,330 Other antidepressant drugs 19,133 0.44 0.56 0.07 -1.79
Fluticasone propionate (Nasal) 208 Drugs used in nasal allergy 6,249 0.03 0.13 0.06 -1.71
Light liquid paraffin 32 Emollient bath and shower preparations 267 0.12 0.33 0.13 -1.67
Olopatadine 16 Other anti-inflammatory preparations 698 0.02 0.18 0.10 -1.62
Clindamycin phosphate 16 Topical preparations for acne 1,008 0.02 0.06 0.03 -1.60
Sertraline hydrochloride 16,701 Selective serotonin re-uptake inhibitors 44,975 0.37 0.46 0.06 -1.58
Spironolactone 1,814 Potassium-sparing diuretics and aldosterone antagonists 3,199 0.57 0.72 0.10 -1.58