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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Guaifenesin 1 Expectorant and demulcent cough preparations 1 1.00 0.03 0.11 8.83
Calcium polystyrene sulfonate 9 Oral potassium 33 0.27 0.01 0.04 6.73
Levofloxacin 23 Antibacterials 387 0.06 0.01 0.01 5.98
Triptorelin acetate 59 Prostate cancer and gonadorelin analogues 228 0.26 0.02 0.05 5.19
Telmisartan 851 Angiotensin-II receptor antagonists 10,116 0.08 0.01 0.01 4.90
Dicycloverine hydrochloride 43 Antispasmodic and other drugs altering gut motility 1,248 0.03 0.01 0.01 4.31
Fluocinonide 26 Topical corticosteroids 3,739 0.01 0.00 0.00 4.17
Telmisartan with diuretic 96 Angiotensin-II receptor antagonists 10,116 0.01 0.00 0.00 3.83
Sotalol hydrochloride 675 Beta-adrenoceptor blocking drugs 17,893 0.04 0.01 0.01 3.71
Nepafenac 40 Ocular diagnostic & peri-operative prepn & photodynamic tt 57 0.70 0.13 0.16 3.50

Prescribing where Watermead PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Simple 0 Expectorant and demulcent cough preparations 1 0.00 0.96 0.12 -7.70
    Potassium chloride 24 Oral potassium 33 0.73 0.97 0.07 -3.33
    Methylprednisolone acetate 1 Local corticosteroid injections 232 0.00 0.73 0.29 -2.50
    Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 14 0.00 0.67 0.28 -2.44
      Omeprazole 3,625 Proton pump inhibitors 24,770 0.15 0.51 0.15 -2.41
      Ivermectin 11 Topical preparation for rosacea 18 0.61 0.89 0.11 -2.39
      Mometasone furoate 259 Drugs used in nasal allergy 2,296 0.11 0.32 0.10 -2.14
      Hyoscine butylbromide 255 Antispasmodic and other drugs altering gut motility 1,248 0.20 0.33 0.06 -2.07
      Alprostadil 2 Drugs for erectile dysfunction 1,370 0.00 0.02 0.01 -1.99
      Umeclidinium bromide/vilanterol 4 Compound bronchodilator preparations 293 0.01 0.50 0.25 -1.95