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Prototype Prescribing Outlier Dashboard for Hadwen Quedgeley 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 Hadwen Quedgeley PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Eluxadoline 1 Antispasmodic and other drugs altering gut motility 1,117 0.00 0.00 0.00 97.01
Nicotine bitartrate 9 Nicotine dependence 31 0.29 0.01 0.02 12.13
Ospemifene 7 Preparations for vaginal/vulval changes 415 0.02 0.00 0.00 11.97
Dextromethorphan hydrobromide 11 Cough suppressants 23 0.48 0.01 0.04 10.97
Reboxetine 66 Other antidepressant drugs 4,957 0.01 0.00 0.00 7.57
Fidaxomicin 2 Some other antibacterials 38 0.05 0.00 0.01 7.10
Saxagliptin 290 Other antidiabetic drugs 2,543 0.11 0.01 0.02 6.08
Acetazolamide 86 Treatment of glaucoma 1,388 0.06 0.01 0.01 5.72
Clemastine fumarate 3 Antihistamines 2,514 0.00 0.00 0.00 5.41
Amiloride hydrochloride with loop diuretics 3 Potassium sparing diuretics and compounds 14 0.21 0.01 0.04 5.38

Prescribing where Hadwen Quedgeley PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium citrate 0 Drugs used in urological pain 1 0.00 0.93 0.19 -4.82
    Procyclidine hydrochloride 94 Antimuscarinic drugs used in parkinsonism 256 0.37 0.85 0.11 -4.50
    Senna 651 Stimulant laxatives 2,979 0.22 0.56 0.11 -3.17
    Naloxegol 19 Peripheral opioid-receptor antagonists 31 0.61 0.97 0.13 -2.72
    Carbimazole 107 Antithyroid drugs 129 0.83 0.93 0.04 -2.40
    Nicotine 3 Nicotine dependence 31 0.10 0.68 0.24 -2.39
    Methylprednisolone acetate 3 Local corticosteroid injections 47 0.06 0.73 0.29 -2.30
    Insulin aspart 415 Short-acting insulins 689 0.60 0.79 0.09 -2.22
    Lactulose 177 Osmotic laxatives 1,504 0.12 0.27 0.07 -2.13
    Salicylic acid 3 Preparations for warts and calluses 14 0.21 0.65 0.22 -2.01