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Prototype Prescribing Outlier Dashboard for Bradford On Avon & Melksham 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 Bradford On Avon & Melksham PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Betamethasone sodium phosphate 290 Otitis externa 820 0.35 0.03 0.04 7.59
Aluminium and magnesium and oxetacaine 10 Antacids and simeticone 17 0.59 0.03 0.08 6.88
Ofloxacin 58 Antibacterials 405 0.14 0.01 0.02 6.19
Quinidine sulfate 3 Drugs for arrhythmias 644 0.00 0.00 0.00 5.90
Sulfur 1 Topical preparations for acne 504 0.00 0.00 0.00 5.33
Dexamethasone phosphate 46 Use of corticosteroids 4,004 0.01 0.00 0.00 5.27
Neomycin sulfate 1 Aminoglycosides 1 1.00 0.04 0.18 5.27
Other soothing haemorrhoidal preparations 3 Soothing haemorrhoidal preparations 34 0.09 0.00 0.02 4.80
Chlohexidine gluconate (Emollient) 8 Emollients 1,393 0.01 0.00 0.00 4.50
Midazolam maleate 21 Drugs used in status epilepticus 24 0.88 0.18 0.17 4.13

Prescribing where Bradford On Avon & Melksham PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Midazolam hydrochloride 3 Drugs used in status epilepticus 24 0.12 0.79 0.17 -3.87
Dexamethasone 433 Otitis externa 820 0.53 0.78 0.07 -3.42
Memantine hydrochloride 68 Drugs for dementia 2,626 0.03 0.38 0.11 -3.14
Phenoxymethylpenicillin (Penicillin V) 1,021 Benzylpenicillin and phenoxymethylpenicillin 1,022 1.00 1.00 0.00 -2.30
Estriol 228 Preparations for vaginal/vulval changes 1,561 0.15 0.44 0.15 -2.00
Melatonin 43 Hypnotics 3,427 0.01 0.18 0.09 -1.90
Gentamicin sulfate 0 Aminoglycosides 1 0.00 0.74 0.41 -1.80
    Topiramate 252 Control of epilepsy 14,346 0.02 0.04 0.01 -1.78
    Tacrolimus 6 Corticosteroids and other immunosuppressants 47 0.13 0.61 0.28 -1.70
    Simvastatin 7,119 Lipid-regulating drugs 54,593 0.13 0.22 0.05 -1.69