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Prototype Prescribing Outlier Dashboard for East Hants 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 East Hants PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Olanzapine embonate 75 Antipsychotic depot injections 254 0.30 0.00 0.01 27.24
Nevirapine 1 HIV infection 2 0.50 0.00 0.03 14.68
Caffeine 7 CNS Stimulants and drugs used for ADHD 1,247 0.01 0.00 0.00 14.06
Alverine citrate/simeticone 19 Antispasmodic and other drugs altering gut motility 2,524 0.01 0.00 0.00 10.93
Heparin calcium 1 Parenteral anticoagulants 152 0.01 0.00 0.00 5.74
Emtricitabine and tenofovir alafenamide 1 HIV infection 2 0.50 0.02 0.11 4.38
Dimenhydrinate/cinnarizine 31 Drugs used in nausea and vertigo 3,790 0.01 0.00 0.00 4.34
Cefaclor 29 Cephalosporins 564 0.05 0.01 0.01 3.62
Dicycloverine hydrochloride 69 Antispasmodic and other drugs altering gut motility 2,524 0.03 0.01 0.01 3.24
Magnesium hydroxide 24 Antacids and simeticone 60 0.40 0.04 0.12 3.07

Prescribing where East Hants PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other emollient preparations 2,166 Emollients 2,775 0.78 0.89 0.04 -2.55
Zinc sulfate monohydrate 0 Zinc 5 0.00 0.74 0.33 -2.26
    Mercaptopurine 43 Antimetabolites 157 0.27 0.81 0.27 -1.96
    Glycopyrronium bromide 1 Antimuscarinic drugs 13 0.08 0.78 0.36 -1.93
    Salicylic acid 40 Preparations for warts and calluses 135 0.30 0.65 0.22 -1.63
    Vitamin A 3 Vitamin A 9 0.33 0.82 0.32 -1.53
    Benzoyl peroxide and clindamycin phosphate 282 Topical preparations for acne 1,095 0.26 0.37 0.07 -1.48
    Ertapenem sodium 0 Carbapenems 4 0.00 0.65 0.47 -1.40
      Lansoprazole 12,282 Proton pump inhibitors 53,477 0.23 0.43 0.15 -1.38
      Ranolazine 77 Other antianginal drugs 926 0.08 0.25 0.13 -1.35