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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-danthramer (Dantron/poloxamer 188) 20 Stimulant laxatives 1,506 0.01 0.00 0.00 19.01
Paraldehyde 3 Drugs used in status epilepticus 5 0.60 0.02 0.06 9.53
Solifenacin/tamsulosin 109 Drugs for urinary retention 1,377 0.08 0.01 0.01 8.91
Asenapine 9 Drugs used for mania and hypomania 358 0.03 0.00 0.00 8.81
Dimenhydrinate/cinnarizine 16 Drugs used in nausea and vertigo 1,617 0.01 0.00 0.00 5.34
Chloramphenicol 3 Otitis externa 313 0.01 0.00 0.00 5.16
Hydrogen peroxide 5 Mouth-washes, gargles and dentifrices 37 0.14 0.01 0.03 4.84
Ciprofloxacin/fluocinolone 10 Otitis externa 313 0.03 0.00 0.01 4.84
Prednisolone sodium metasulphobenzoate 8 Corticosteroids 10 0.80 0.15 0.14 4.80
Moxifloxacin hydrochloride 5 Ocular diagnostic & peri-operative prepn & photodynamic tt 17 0.29 0.02 0.06 4.72

Prescribing where Oasis PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Budesonide 2 Corticosteroids 10 0.20 0.72 0.18 -2.96
Chlorhexidine gluconate 32 Mouth-washes, gargles and dentifrices 37 0.86 0.98 0.05 -2.45
Midazolam hydrochloride 2 Drugs used in status epilepticus 5 0.40 0.79 0.17 -2.28
Flecainide acetate 21 Drugs for arrhythmias 156 0.13 0.46 0.15 -2.17
Carbimazole 161 Antithyroid drugs 191 0.84 0.93 0.04 -2.09
Combined ethinylestradiol 35mcg 9 Combined hormonal contraceptives 635 0.01 0.05 0.02 -2.01
Vitamin A 3 Vitamin A 16 0.19 0.82 0.32 -1.99
Ulipristal acetate (Emergency Contraceptive) 1 Emergency contraception 11 0.09 0.40 0.16 -1.97
Lamotrigine 377 Control of epilepsy 5,891 0.06 0.11 0.03 -1.95
Dorzolamide and timolol 43 Treatment of glaucoma 1,509 0.03 0.09 0.03 -1.92