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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Flunarizine dihydrochloride 13 Drugs used in nausea and vertigo 2,060 0.01 0.00 0.00 8.18
Ciclosporin 8 Tear deficiency, eye lubricant/astringent 492 0.02 0.00 0.00 8.01
Linezolid 5 Some other antibacterials 43 0.12 0.01 0.02 6.47
Captopril 111 Angiotensin-converting enzyme inhibitors 14,361 0.01 0.00 0.00 6.27
Gemfibrozil 32 Lipid-regulating drugs 25,019 0.00 0.00 0.00 6.21
Diamorphine hydrochloride (Systemic) 37 Opioid analgesics 4,610 0.01 0.00 0.00 5.83
Diazoxide 16 Treatment of hypoglycaemia 129 0.12 0.01 0.02 5.80
Co-danthramer (Dantron/poloxamer 188) 8 Stimulant laxatives 2,056 0.00 0.00 0.00 5.37
Meptazinol hydrochloride 258 Opioid analgesics 4,610 0.06 0.00 0.01 5.28
Gluten free/low protein pasta 15 Foods for special diets 231 0.06 0.01 0.01 4.79

Prescribing where Titan PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Urea hydrogen peroxide 0 Removal of ear wax and other substances 1 0.00 0.84 0.24 -3.55
    Desogestrel 834 Oral progestogen-only contraceptives 979 0.85 0.94 0.03 -3.07
    Codeine phosphate 8 Cough suppressants 43 0.19 0.77 0.20 -2.94
    Sulfasalazine 99 Aminosalicylates 893 0.11 0.33 0.09 -2.41
    Salbutamol 6,366 Selective beta(2)-agonists 7,667 0.83 0.90 0.03 -2.33
    Potassium chloride 13 Oral potassium 16 0.81 0.97 0.07 -2.14
    Methotrexate 379 Rheumatic disease suppressant drugs 1,084 0.35 0.58 0.11 -2.14
    Itraconazole 1 Triazole antifungals 141 0.01 0.14 0.06 -2.09
    Sodium picosulfate 0 Bowel cleansing preparations 11 0.00 0.70 0.35 -2.04
      Pregabalin 1,191 Control of epilepsy 7,625 0.16 0.27 0.06 -2.03