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Prototype Prescribing Outlier Dashboard for St Helens Central 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 St Helens Central PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Darifenacin hydrobromide 972 Drugs for urinary frequency enuresis and incontinence 4,003 0.24 0.01 0.03 8.98
Insulin glulisine 429 Short-acting insulins 1,276 0.34 0.03 0.04 7.59
Modafinil 19 CNS Stimulants and drugs used for ADHD 43 0.44 0.06 0.05 7.42
Fluorometholone 74 Corticosteroids 169 0.44 0.09 0.05 6.95
Liraglutide 454 Other antidiabetic drugs 3,322 0.14 0.03 0.02 5.91
Levothyroxine sodium and liothyronine 15 Thyroid hormones 11,696 0.00 0.00 0.00 5.86
Other soothing haemorrhoidal preparations 9 Soothing haemorrhoidal preparations 85 0.11 0.00 0.02 5.82
Urine testing reagents 193 Diabetic diagnostic and monitoring agents 2,754 0.07 0.01 0.01 4.90
Methocarbamol 466 Skeletal muscle relaxants 805 0.58 0.09 0.11 4.39
Dexamethasone sodium phosphate 2 Use of corticosteroids 2,303 0.00 0.00 0.00 4.20

Prescribing where St Helens Central PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Levonorgestrel 0 Emergency contraception 1 0.00 0.60 0.16 -3.75
    Baclofen 319 Skeletal muscle relaxants 805 0.40 0.81 0.12 -3.54
    Insulin aspart 676 Short-acting insulins 1,276 0.53 0.79 0.09 -3.07
    Hydralazine hydrochloride 21 Vasodilator antihypertensive drugs 60 0.35 0.86 0.17 -3.00
    Glucose blood testing reagents 2,409 Diabetic diagnostic and monitoring agents 2,754 0.87 0.94 0.02 -2.88
    Other multivitamin preparations 635 Multivitamin preparations 1,528 0.42 0.81 0.14 -2.83
    Macrogol 3350 2,791 Osmotic laxatives 5,096 0.55 0.72 0.07 -2.44
    Vitamin A 3 Vitamin A 47 0.06 0.82 0.32 -2.38
    Tacrolimus 33 Drugs affecting the immune response 60 0.55 0.80 0.11 -2.36
    Co-amoxiclav (Amoxicillin/clavulanic acid) 109 Broad-spectrum penicillins 3,335 0.03 0.15 0.05 -2.32