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Prototype Prescribing Outlier Dashboard for Three Harbours And Bosvena 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 Three Harbours And Bosvena PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Prilocaine hydrochloride 16 Local anaesthetics 649 0.02 0.00 0.00 18.46
Benzalkonium chloride 499 Barrier preparations 1,101 0.45 0.05 0.08 4.73
Low protein meals 9 Foods for special diets 269 0.03 0.00 0.01 4.54
Estradiol and nomegestrol 15 Combined hormonal contraceptives 1,807 0.01 0.00 0.00 4.26
Trimetazidine hydrochloride 11 Calcium-channel blockers 26,187 0.00 0.00 0.00 4.19
Estradiol valandestradiol valerate with dienogest 14 Combined hormonal contraceptives 1,807 0.01 0.00 0.00 4.12
Diamorphine hydrochloride (Systemic) 70 Opioid analgesics 12,020 0.01 0.00 0.00 4.11
Linaclotide 16 Other drugs used in constipation 16 1.00 0.27 0.19 3.96
Flumetasone pivalate 12 Otitis externa 641 0.02 0.00 0.00 3.66
Perphenazine 4 Antipsychotic drugs 5,923 0.00 0.00 0.00 3.58

Prescribing where Three Harbours And Bosvena PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Prucalopride 0 Other drugs used in constipation 16 0.00 0.73 0.19 -3.96
    Tacrolimus 13 Drugs affecting the immune response 26 0.50 0.80 0.11 -2.83
    Alcohol 0 Alcohols and saline 1 0.00 0.87 0.33 -2.62
      Colecalciferol 9,138 Vitamin D 9,785 0.93 0.97 0.01 -2.23
      Ramipril 10,845 Angiotensin-converting enzyme inhibitors 27,133 0.40 0.70 0.14 -2.19
      Glycopyrronium bromide 8 Antimuscarinic drugs 131 0.06 0.78 0.36 -1.97
      Zinc oxide 73 Barrier preparations 1,101 0.07 0.51 0.23 -1.95
      Levothyroxine sodium 21,927 Thyroid hormones 22,042 0.99 1.00 0.00 -1.91
      Tamoxifen citrate 174 Breast cancer 1,406 0.12 0.27 0.08 -1.87
      Gentamicin sulfate 0 Aminoglycosides 3 0.00 0.74 0.41 -1.80