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Prototype Prescribing Outlier Dashboard for Walsall North 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 Walsall North PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nystatin 23 Antifungal preparations 652 0.04 0.00 0.00 9.45
Bempedoic acid/Ezetimibe 19 Lipid-regulating drugs 40,063 0.00 0.00 0.00 6.37
Phased formulations of ethinylestradiol 73 Combined hormonal contraceptives 1,504 0.05 0.01 0.01 6.01
Dapagliflozin/metformin 329 Other antidiabetic drugs 9,205 0.04 0.00 0.01 4.97
Bupivacaine hydrochloride 60 Local anaesthetics 402 0.15 0.01 0.03 4.31
Calcium acetate/magnesium carbonate 40 Phosphate binding agents 63 0.63 0.05 0.14 4.28
Sodium chloride 66 Electrolytes and water 79 0.84 0.18 0.15 4.28
Olmesartan medoxomil/amlodipine/hydrochlorothiazide 65 Angiotensin-II receptor antagonists 8,500 0.01 0.00 0.00 4.20
Levobunolol hydrochloride 37 Treatment of glaucoma 4,816 0.01 0.00 0.00 3.95
Olmesartan medoxomil/amlodipine 65 Angiotensin-II receptor antagonists 8,500 0.01 0.00 0.00 3.80

Prescribing where Walsall North PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Water for injection 13 Electrolytes and water 79 0.16 0.82 0.16 -4.14
Allopurinol 2,287 Gout and cytotoxic induced hyperiuicaemia 2,806 0.82 0.90 0.03 -3.18
Olanzapine 1,082 Antipsychotic drugs 10,422 0.10 0.22 0.05 -2.24
Lithium carbonate 356 Drugs used for mania and hypomania 1,591 0.22 0.62 0.18 -2.23
Clarithromycin 820 Macrolides 2,433 0.34 0.58 0.12 -2.13
Mercaptopurine 8 Antimetabolites 34 0.24 0.81 0.27 -2.10
Ivermectin 20 Topical preparation for rosacea 31 0.65 0.89 0.11 -2.09
Ketoconazole 222 Shampoos and some other scalp preparations 662 0.34 0.50 0.08 -1.99
Co-beneldopa (Benserazide/levodopa) 61 Dopaminergic drugs used in parkinsonism 1,665 0.04 0.23 0.10 -1.92
Moxonidine 67 Centrally-acting antihypertensive drugs 202 0.33 0.69 0.19 -1.83