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Prototype Prescribing Outlier Dashboard for Newham Central 1 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 Newham Central 1 PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other magnesium preparations 24 Magnesium 27 0.89 0.01 0.05 17.24
Low protein cakes 18 Foods for special diets 645 0.03 0.00 0.00 5.75
Linagliptin/metformin 1,095 Other antidiabetic drugs 22,989 0.05 0.00 0.01 5.51
Ranitidine hydrochloride 74 H2-Receptor antagonists 470 0.16 0.01 0.03 5.21
Gluten free/low protein biscuits 32 Foods for special diets 645 0.05 0.00 0.01 5.11
Gluten free/low protein mixes 16 Foods for special diets 645 0.02 0.00 0.00 5.09
Sodium zirconium cyclosilicate 12 Oral potassium 48 0.25 0.01 0.05 4.95
Isosorbide dinitrate 289 Nitrates 3,965 0.07 0.01 0.01 4.55
Heparin flushes 28 Parenteral anticoagulants 96 0.29 0.03 0.06 4.53
Alendronic acid/colecalciferol 28 Bisphosphonates and other drugs 3,501 0.01 0.00 0.00 4.08

Prescribing where Newham Central 1 PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium chloride 36 Oral potassium 48 0.75 0.97 0.07 -3.01
Codeine phosphate 19 Cough suppressants 103 0.18 0.77 0.20 -2.95
Glucose 94 Treatment of hypoglycaemia 173 0.54 0.77 0.09 -2.56
Methotrexate 455 Rheumatic disease suppressant drugs 1,341 0.34 0.58 0.11 -2.24
Aciclovir 225 Herpes simplex and varicella-zoster 258 0.87 0.95 0.04 -2.17
Morphine sulfate 484 Opioid analgesics 5,119 0.09 0.21 0.06 -2.11
Combined ethinylestradiol 35mcg 9 Combined hormonal contraceptives 733 0.01 0.05 0.02 -2.11
Doxycycline hyclate 530 Tetracyclines 1,014 0.52 0.70 0.08 -2.07
Sodium picosulfate 0 Bowel cleansing preparations 8 0.00 0.70 0.35 -2.04
    Ciprofloxacin 116 Quinolones 168 0.69 0.86 0.08 -2.02