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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Diphtheria 483 Vaccines and antisera 3,140 0.15 0.0 0.01 12.33
Low protein desserts 26 Foods for special diets 438 0.06 0.0 0.00 12.21
Gluten free/low protein cereals 24 Foods for special diets 438 0.05 0.0 0.00 12.11
Piroxicam 50 Non-steroidal anti-inflammatory drugs 2,843 0.02 0.0 0.00 10.49
Rilpivirine 1 HIV infection 2 0.50 0.0 0.06 8.91
Alkyl sulfate 12 Shampoos and some other scalp preparations 451 0.03 0.0 0.00 8.57
Cefuroxime sodium 1 Cephalosporins 232 0.00 0.0 0.00 7.71
Dicycloverine hydrochloride compound preparations 30 Antispasmodic and other drugs altering gut motility 928 0.03 0.0 0.00 6.43
Dequalinium chloride 5 Vaginal and vulval infections 282 0.02 0.0 0.00 6.21
Oxcarbazepine 178 Control of epilepsy 6,973 0.03 0.0 0.00 5.88

Prescribing where North Merton PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Influenza 2,134 Vaccines and antisera 3,140 0.68 0.96 0.07 -4.00
Codeine phosphate 34 Cough suppressants 171 0.20 0.77 0.20 -2.88
Vitamin A 1 Vitamin A 70 0.01 0.82 0.32 -2.54
Naproxen 1,521 Non-steroidal anti-inflammatory drugs 2,843 0.53 0.69 0.06 -2.49
Zinc sulfate monohydrate 0 Zinc 1 0.00 0.74 0.33 -2.26
    Duloxetine hydrochloride 193 Other antidepressant drugs 4,547 0.04 0.16 0.05 -2.17
    Hyoscine butylbromide 189 Antispasmodic and other drugs altering gut motility 928 0.20 0.33 0.06 -2.08
    Ibuprofen 675 Rubefacients, topical NSAIDS, capsaicin and poultice 3,501 0.19 0.52 0.16 -2.06
    Morphine sulfate 315 Opioid analgesics 3,150 0.10 0.21 0.06 -2.02
    Dexamethasone 13 Use of corticosteroids 1,817 0.01 0.03 0.01 -1.97