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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenindione 14 Oral anticoagulants 9,789 0.00 0.00 0.00 13.95
Other mouth wash, gargle and dentifrice preparations 8 Mouth-washes, gargles and dentifrices 66 0.12 0.00 0.02 5.35
Empagliflozin/metformin 626 Other antidiabetic drugs 9,341 0.07 0.00 0.01 5.12
Acetazolamide 173 Treatment of glaucoma 3,079 0.06 0.01 0.01 5.06
Safinamide 126 Dopaminergic drugs used in parkinsonism 2,484 0.05 0.00 0.01 4.98
Paraffin soft yellow 5 Emollients 1,152 0.00 0.00 0.00 4.54
Canagliflozin/metformin 90 Other antidiabetic drugs 9,341 0.01 0.00 0.00 4.36
Quinagolide hydrochloride 12 Bromocriptine and other dopaminergic drugs 25 0.48 0.05 0.10 4.19
Gentamicin sulfate 89 Antibacterials 650 0.14 0.03 0.03 3.36
Glimepiride 1,584 Sulfonylureas 3,609 0.44 0.07 0.11 3.35

Prescribing where North Halifax PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gliclazide 2,025 Sulfonylureas 3,609 0.56 0.93 0.11 -3.31
Chlorhexidine gluconate 58 Mouth-washes, gargles and dentifrices 66 0.88 0.98 0.05 -2.15
Glycopyrronium bromide 0 Antimuscarinic drugs 1 0.00 0.78 0.36 -2.14
    Cabergoline 13 Bromocriptine and other dopaminergic drugs 25 0.52 0.85 0.16 -2.04
    Co-careldopa (Carbidopa/levodopa) 194 Dopaminergic drugs used in parkinsonism 2,484 0.08 0.32 0.12 -1.98
    Zopiclone 1,793 Hypnotics 3,948 0.45 0.61 0.09 -1.77
    Ipratropium bromide 9 Topical nasal decongestants 194 0.05 0.36 0.18 -1.76
    Mirabegron 633 Drugs for urinary frequency enuresis and incontinence 4,765 0.13 0.23 0.06 -1.75
    Venlafaxine 2,120 Other antidepressant drugs 13,306 0.16 0.27 0.06 -1.73
    Domperidone 40 Drugs used in nausea and vertigo 3,864 0.01 0.05 0.02 -1.70