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Prototype Prescribing Outlier Dashboard for North Lincolnshire West 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 Lincolnshire West PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Fosphenytoin sodium 1 Drugs used in status epilepticus 23 0.04 0.00 0.00 61.53
Frovatriptan 249 Treatment of acute migraine 1,739 0.14 0.02 0.02 8.14
Cetylpyridinium chloride 5 Mouth-washes, gargles and dentifrices 77 0.06 0.00 0.01 6.69
Opium and morphine 7 Antimotility drugs 817 0.01 0.00 0.00 4.44
Olmesartan medoxomil 1,399 Angiotensin-II receptor antagonists 11,714 0.12 0.02 0.02 4.43
Ospemifene 4 Preparations for vaginal/vulval changes 639 0.01 0.00 0.00 4.32
Glimepiride 1,699 Sulfonylureas 3,219 0.53 0.07 0.11 4.15
Biphasic insulin aspart 1,138 Intermediate and long-acting insulins 2,758 0.41 0.14 0.07 3.97
Hydrochlorothiazide 11 Thiazides and related diuretics 6,694 0.00 0.00 0.00 3.91
Disulfiram 10 Alcohol dependence 10 1.00 0.16 0.23 3.68

Prescribing where North Lincolnshire West PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gliclazide 1,513 Sulfonylureas 3,219 0.47 0.93 0.11 -4.13
Acamprosate calcium 0 Alcohol dependence 10 0.00 0.83 0.23 -3.54
    Hydralazine hydrochloride 13 Vasodilator antihypertensive drugs 40 0.32 0.86 0.17 -3.15
    Ketoconazole 192 Shampoos and some other scalp preparations 647 0.30 0.50 0.08 -2.46
    Loperamide hydrochloride 806 Antimotility drugs 817 0.99 1.00 0.00 -2.26
    Estradiol 156 Preparations for vaginal/vulval changes 639 0.24 0.56 0.15 -2.18
    Sumatriptan succinate 907 Treatment of acute migraine 1,739 0.52 0.66 0.06 -2.11
    Ivermectin 17 Topical preparation for rosacea 26 0.65 0.89 0.11 -2.02
    Prednisolone 35 Copound haemorrhoidal preparations with corticosteroid 404 0.09 0.44 0.18 -1.91
    Lisdexamfetamine dimesylate 3 CNS Stimulants and drugs used for ADHD 210 0.01 0.15 0.08 -1.82