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Prototype Prescribing Outlier Dashboard for North Watford 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 North Watford PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tinidazole 1 Metronidazole, tinidazole and ornidazole 90 0.01 0.00 0.00 15.96
Sodium bicarbonate 6 Electrolytes and water 26 0.23 0.00 0.03 8.71
Low protein grains/flours 10 Foods for special diets 311 0.03 0.00 0.00 8.66
Low protein cooking aids 7 Foods for special diets 311 0.02 0.00 0.00 8.55
Perampanel 102 Control of epilepsy 5,831 0.02 0.00 0.00 8.07
Pilocarpine hydrochloride 53 Treatment of glaucoma 1,786 0.03 0.00 0.00 7.41
Low protein desserts 9 Foods for special diets 311 0.03 0.00 0.00 5.80
Formaldehyde 1 Preparations for warts and calluses 18 0.06 0.00 0.01 5.70
Minoxidil 7 Shampoos and some other scalp preparations 182 0.04 0.00 0.01 5.66
Low protein mixes 32 Foods for special diets 311 0.10 0.01 0.02 5.31

Prescribing where North Watford PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Metronidazole 89 Metronidazole, tinidazole and ornidazole 90 0.99 1.00 0.00 -15.96
Desogestrel 539 Oral progestogen-only contraceptives 658 0.82 0.94 0.03 -4.25
Prucalopride 5 Other drugs used in constipation 24 0.21 0.73 0.19 -2.83
Glucose 27 Treatment of hypoglycaemia 49 0.55 0.77 0.09 -2.48
Memantine hydrochloride 73 Drugs for dementia 679 0.11 0.38 0.11 -2.42
Nicotine 4 Nicotine dependence 44 0.09 0.68 0.24 -2.42
Midazolam hydrochloride 8 Drugs used in status epilepticus 20 0.40 0.79 0.17 -2.28
Loperamide hydrochloride 316 Antimotility drugs 320 0.99 1.00 0.00 -2.06
Oral rehydration salts 37 Oral sodium and water 138 0.27 0.65 0.20 -1.94
Hydrocortisone 57 Copound haemorrhoidal preparations with corticosteroid 275 0.21 0.56 0.18 -1.93