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Prototype Prescribing Outlier Dashboard for The Mast 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 The Mast PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Disodium edetate 2 Ocular diagnostic & peri-operative prepn & photodynamic tt 46 0.04 0.00 0.00 35.36
Nedocromil sodium 1 Cromoglycate and related therapy 1 1.00 0.02 0.13 7.47
Apomorphine hydrochloride hemihydrate 14 Dopaminergic drugs used in parkinsonism 2,001 0.01 0.00 0.00 6.25
Nicotine bitartrate 13 Nicotine dependence 88 0.15 0.01 0.02 6.04
Taurine 3 Amino acids and nutritional agents 3 1.00 0.04 0.16 5.96
Co-flumactone (Hydroflumethiazide/spironolactone) 6 Potassium sparing diuretics and compounds 122 0.05 0.00 0.01 5.16
Lormetazepam 33 Hypnotics 2,009 0.02 0.00 0.00 5.11
Co-danthramer (Dantron/poloxamer 188) 8 Stimulant laxatives 2,278 0.00 0.00 0.00 4.82
Ramipril with calcium channel blocker 21 Angiotensin-converting enzyme inhibitors 14,524 0.00 0.00 0.00 4.16
Ethambutol hydrochloride 8 Antituberculosis drugs 11 0.73 0.07 0.17 3.78

Prescribing where The Mast PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium cromoglicate 0 Cromoglycate and related therapy 1 0.00 0.98 0.13 -7.47
    Other amino acidandnutritional agent preparations 0 Amino acids and nutritional agents 3 0.00 0.96 0.16 -5.96
      Procyclidine hydrochloride 166 Antimuscarinic drugs used in parkinsonism 269 0.62 0.85 0.11 -2.18
      Zinc oxide 18 Soothing haemorrhoidal preparations 33 0.55 0.78 0.13 -1.77
      Brimonidine tartrate 25 Treatment of glaucoma 3,502 0.01 0.03 0.01 -1.73
      Hypromellose 266 Tear deficiency, eye lubricant/astringent 978 0.27 0.45 0.11 -1.68
      Fusidic acid 164 Antibacterial preparations also used systemically 271 0.61 0.75 0.09 -1.62
      Clindamycin phosphate 8 Topical preparations for acne 517 0.02 0.06 0.03 -1.62
      Co-codamol (Codeine phosphate/paracetamol) 2,720 Non-opioid analgesics and compound preparations 11,078 0.25 0.44 0.12 -1.60
      Crotamiton 5 Topical local anaesthetics and antipruritics 49 0.10 0.33 0.15 -1.53