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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Olodaterol 29 Selective beta(2)-agonists 7,812 0.00 0.00 0.00 11.65
Titanium dioxide 3 Sunscreening preparations 141 0.02 0.00 0.00 5.23
Nadolol 69 Beta-adrenoceptor blocking drugs 23,743 0.00 0.00 0.00 4.67
Fosinopril sodium 28 Angiotensin-converting enzyme inhibitors 22,791 0.00 0.00 0.00 4.52
Medroxyprogesterone acetate 93 Progestogens and progesterone receptor modulators 187 0.50 0.13 0.08 4.36
Rizatriptan 410 Treatment of acute migraine 1,331 0.31 0.11 0.05 4.13
Cabergoline 31 Dopaminergic drugs used in parkinsonism 2,554 0.01 0.00 0.00 3.92
Nitrazepam 232 Hypnotics 1,703 0.14 0.04 0.02 3.85
Terbutaline sulphate 433 Selective beta(2)-agonists 7,812 0.06 0.02 0.01 3.72
Colistimethate sodium 40 Some other antibacterials 58 0.69 0.15 0.15 3.66

Prescribing where Torentum PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Salbutamol 6,357 Selective beta(2)-agonists 7,812 0.81 0.90 0.03 -2.85
Urea hydrogen peroxide 1 Removal of ear wax and other substances 5 0.20 0.84 0.24 -2.70
Famotidine 158 H2-Receptor antagonists 290 0.54 0.83 0.11 -2.49
Estradiol 335 Oestrogens and Hormone Replacement Therapy 1,145 0.29 0.49 0.09 -2.18
Mesalazine (Systemic) 592 Aminosalicylates 1,353 0.44 0.64 0.10 -2.14
Latanoprost 769 Treatment of glaucoma 4,655 0.17 0.31 0.07 -2.14
Adapalene 10 Topical preparations for acne 420 0.02 0.11 0.04 -2.10
Combined ethinylestradiol 30mcg 444 Combined hormonal contraceptives 608 0.73 0.81 0.04 -1.91
Ketoconazole 97 Shampoos and some other scalp preparations 279 0.35 0.50 0.08 -1.85
Light liquid paraffin 7 Emollient bath and shower preparations 69 0.10 0.33 0.13 -1.82