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Prototype Prescribing Outlier Dashboard for Cheetham Hill & Crumpsall 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 Cheetham Hill & Crumpsall PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Enzalutamide 7 Prostate cancer and gonadorelin analogues 161 0.04 0.00 0.00 50.58
Quinapril hydrochloride with diuretic 16 Angiotensin-converting enzyme inhibitors 20,458 0.00 0.00 0.00 15.52
Bictegravir/emtricitabine/tenofovir alafenamide 2 HIV infection 4 0.50 0.01 0.05 10.35
Zidovudine 1 HIV infection 4 0.25 0.00 0.03 9.18
Dicycloverine hydrochloride compound preparations 109 Antispasmodic and other drugs altering gut motility 3,017 0.04 0.00 0.00 7.25
Alogliptin/metformin 1,231 Other antidiabetic drugs 16,124 0.08 0.00 0.01 6.16
Canagliflozin/metformin 209 Other antidiabetic drugs 16,124 0.01 0.00 0.00 5.98
Dimenhydrinate/cinnarizine 33 Drugs used in nausea and vertigo 3,375 0.01 0.00 0.00 5.27
Avanafil 77 Drugs for erectile dysfunction 3,893 0.02 0.00 0.00 5.06
Penicillamine 30 Rheumatic disease suppressant drugs 1,188 0.03 0.00 0.00 4.87

Prescribing where Cheetham Hill & Crumpsall PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ursodeoxycholic acid 138 Drugs affecting biliary composition and flow 146 0.95 1.00 0.00 -39.07
Isosorbide mononitrate 1,774 Nitrates 3,274 0.54 0.73 0.07 -2.77
Neomycin sulfate 196 Nasal preparations for infection 295 0.66 0.83 0.07 -2.45
Fluconazole 263 Triazole antifungals 374 0.70 0.86 0.07 -2.33
Progesterone 46 Progestogens and progesterone receptor modulators 345 0.13 0.59 0.20 -2.29
Desogestrel 513 Oral progestogen-only contraceptives 587 0.87 0.94 0.03 -2.27
Potassium chloride 67 Oral potassium 83 0.81 0.97 0.07 -2.22
Folic acid 2,751 Drugs used in megaloblastic anaemias 7,088 0.39 0.68 0.13 -2.19
Clotrimazole 336 Antifungal preparations 1,603 0.21 0.44 0.11 -2.17
Colecalciferol 10,772 Vitamin D 11,501 0.94 0.97 0.01 -2.03