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Prototype Prescribing Outlier Dashboard for Colte Partnership (Tmr) 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 Colte Partnership (Tmr) PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other lozenge and spray preparations 1 Lozenges and sprays 1 1.00 0.01 0.07 14.35
Empagliflozin/linagliptin 23 Other antidiabetic drugs 3,557 0.01 0.00 0.00 8.33
Galantamine 273 Drugs for dementia 848 0.32 0.03 0.04 7.10
Gluten free/low protein bread 35 Foods for special diets 336 0.10 0.01 0.02 5.89
Dapagliflozin/metformin 143 Other antidiabetic drugs 3,557 0.04 0.00 0.01 5.64
Gluten free/low protein biscuits 15 Foods for special diets 336 0.04 0.00 0.01 4.55
Paraldehyde 8 Drugs used in status epilepticus 29 0.28 0.02 0.06 4.20
Clonazepam 723 Control of epilepsy 7,496 0.10 0.03 0.02 4.09
Sucroferric oxyhydroxide 3 Phosphate binding agents 46 0.07 0.00 0.02 3.98
Docusate sodium 1 Removal of ear wax and other substances 1 1.00 0.15 0.23 3.69

Prescribing where Colte Partnership (Tmr) 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
    Neomycin sulfate 45 Nasal preparations for infection 70 0.64 0.83 0.07 -2.76
    Mirtazapine 1,958 Other antidepressant drugs 5,048 0.39 0.56 0.07 -2.49
    Zinc oxide 0 Barrier preparations 36 0.00 0.51 0.23 -2.24
      Amiodarone hydrochloride 53 Drugs for arrhythmias 324 0.16 0.48 0.15 -2.08
      Sumatriptan succinate 439 Treatment of acute migraine 839 0.52 0.66 0.06 -2.08
      Chlorphenamine maleate 68 Antihistamines 3,567 0.02 0.06 0.02 -1.94
      Magnesium aspartate 1 Magnesium 40 0.02 0.50 0.27 -1.79
      Cyclizine hydrochloride 128 Drugs used in nausea and vertigo 1,375 0.09 0.17 0.04 -1.79
      Hyoscine butylbromide 221 Antispasmodic and other drugs altering gut motility 993 0.22 0.33 0.06 -1.77