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Prototype Prescribing Outlier Dashboard for Shelton & Hanley 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 Shelton & Hanley PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydrocortisone acetate 1 Local corticosteroid injections 29 0.03 0.00 0.00 10.93
Calcitriol 170 Vitamin D 10,542 0.02 0.00 0.00 5.98
Undecenoates 8 Antifungal preparations 419 0.02 0.00 0.00 5.03
Acetylcysteine 741 Mucolytics 2,028 0.37 0.02 0.08 4.42
Alkyl sulfate 6 Shampoos and some other scalp preparations 426 0.01 0.00 0.00 4.31
Heparinoid 354 Rubefacients, topical NSAIDS, capsaicin and poultice 2,815 0.13 0.03 0.02 4.18
Lodoxamide trometamol 48 Other anti-inflammatory preparations 561 0.09 0.02 0.02 4.07
Perampanel 121 Control of epilepsy 12,572 0.01 0.00 0.00 3.98
Colistimethate sodium 54 Some other antibacterials 75 0.72 0.15 0.15 3.87
Tolnaftate 1 Antifungal preparations 419 0.00 0.00 0.00 3.65

Prescribing where Shelton & Hanley PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Carbocisteine 1,262 Mucolytics 2,028 0.62 0.97 0.08 -4.42
Ivermectin 8 Topical preparation for rosacea 14 0.57 0.89 0.11 -2.73
Isosorbide mononitrate 1,350 Nitrates 2,432 0.56 0.73 0.07 -2.57
Lithium carbonate 108 Drugs used for mania and hypomania 535 0.20 0.62 0.18 -2.36
Letrozole 42 Breast cancer 659 0.06 0.44 0.18 -2.08
Terbinafine hydrochloride 119 Other antifungals 124 0.96 0.99 0.02 -2.07
Ticagrelor 11 Antiplatelet drugs 9,810 0.00 0.02 0.01 -2.02
Cyclizine hydrochloride 207 Drugs used in nausea and vertigo 2,420 0.09 0.17 0.04 -1.96
Fluorouracil (Sunscreen) 1 Sunscreening preparations 39 0.03 0.46 0.22 -1.94
Estradiol 85 Preparations for vaginal/vulval changes 295 0.29 0.56 0.15 -1.88