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Prototype Prescribing Outlier Dashboard for A31 Group 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 A31 Group PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Magnesium sulfate 8 Magnesium 26 0.31 0.00 0.02 17.39
Phenindione 10 Oral anticoagulants 6,386 0.00 0.00 0.00 15.29
Desloratadine 294 Antihistamines 3,715 0.08 0.01 0.01 6.44
Perphenazine 4 Antipsychotic drugs 3,656 0.00 0.00 0.00 5.87
Probenecid 6 Gout and cytotoxic induced hyperiuicaemia 2,584 0.00 0.00 0.00 5.83
Phenobarbital sodium 1 Control of epilepsy 7,398 0.00 0.00 0.00 5.23
Quinapril hydrochloride with diuretic 3 Angiotensin-converting enzyme inhibitors 12,144 0.00 0.00 0.00 4.79
Benzalkonium chloride 51 Shampoos and some other scalp preparations 287 0.18 0.04 0.03 4.59
Iron and folic acid 35 Oral iron 2,467 0.01 0.00 0.00 4.10
Imipramine hydrochloride 169 Tricyclic and related antidepressant drugs 5,985 0.03 0.01 0.01 4.05

Prescribing where A31 Group PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aluminium chloride 7 Antiperspirants 8 0.88 0.99 0.04 -3.13
Cabergoline 20 Bromocriptine and other dopaminergic drugs 54 0.37 0.85 0.16 -2.97
Procyclidine hydrochloride 228 Antimuscarinic drugs used in parkinsonism 407 0.56 0.85 0.11 -2.70
Medroxyprogesterone acetate 133 Parenteral progestogen-only contraceptives 219 0.61 0.86 0.10 -2.45
Salicylic acid 5 Preparations for warts and calluses 32 0.16 0.65 0.22 -2.28
Ivermectin 12 Topical preparation for rosacea 19 0.63 0.89 0.11 -2.21
Sodium cromoglicate 108 Other anti-inflammatory preparations 270 0.40 0.64 0.12 -2.10
Finasteride 734 Male sex hormones and antagonists 1,086 0.68 0.83 0.07 -2.08
Terbinafine hydrochloride 21 Antifungal preparations 471 0.04 0.14 0.05 -2.04
Sodium picosulfate 0 Bowel cleansing preparations 1 0.00 0.70 0.35 -2.04