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Prototype Prescribing Outlier Dashboard for Bexhill 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 Bexhill PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nicotine bitartrate 29 Nicotine dependence 150 0.19 0.01 0.02 7.99
Oxazepam 482 Anxiolytics 4,520 0.11 0.01 0.01 6.47
Timolol and brimonidine 240 Treatment of glaucoma 7,366 0.03 0.01 0.01 4.70
Dronedarone hydrochloride 143 Drugs for arrhythmias 881 0.16 0.02 0.04 4.03
Isocarboxazid 6 Monoamine-oxidase inhibitors (maois) 6 1.00 0.08 0.24 3.84
Low protein risotto 2 Foods for special diets 947 0.00 0.00 0.00 3.80
Promethazine hydrochloride 3,059 Antihistamines 6,877 0.44 0.13 0.09 3.62
Pantoprazole 3,431 Proton pump inhibitors 40,004 0.09 0.02 0.02 3.59
Eltrombopag 8 Drugs used in platelet disorders 8 1.00 0.08 0.26 3.52
Hydrocort sodiumphos 45 Antibacterials 653 0.07 0.01 0.02 3.51

Prescribing where Bexhill PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Anagrelide hydrochloride 0 Drugs used in platelet disorders 8 0.00 0.92 0.26 -3.52
    Azathioprine 230 Antiproliferative immunosuppressants 426 0.54 0.80 0.10 -2.56
    Salicylic acid 15 Preparations for warts and calluses 118 0.13 0.65 0.22 -2.41
    Gliclazide 1,436 Sulfonylureas 2,131 0.67 0.93 0.11 -2.29
    Beclometasone dipropionate 4,033 Corticosteroids (respiratory) 11,272 0.36 0.57 0.09 -2.29
    Furosemide 6,091 Loop diuretics 8,719 0.70 0.85 0.07 -2.16
    Diazepam 2,713 Anxiolytics 4,520 0.60 0.76 0.08 -2.07
    Sertraline hydrochloride 8,315 Selective serotonin re-uptake inhibitors 24,083 0.35 0.46 0.06 -2.05
    Glycopyrronium bromide 9 Antimuscarinic drugs 109 0.08 0.78 0.36 -1.91
    Cetirizine hydrochloride 939 Antihistamines 6,877 0.14 0.28 0.08 -1.83