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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other mouth wash, gargle and dentifrice preparations 8 Mouth-washes, gargles and dentifrices 22 0.36 0.00 0.02 16.44
Insulin glargine/lixisenatide 12 Intermediate and long-acting insulins 1,368 0.01 0.00 0.00 9.77
Levocetirizine 114 Antihistamines 4,066 0.03 0.00 0.00 4.79
Rifampicin combined preparations 1 Antituberculosis drugs 2 0.50 0.02 0.10 4.59
Pramipexole 535 Dopaminergic drugs used in parkinsonism 1,319 0.41 0.12 0.07 4.44
Acenocoumarol 45 Oral anticoagulants 6,587 0.01 0.00 0.00 4.33
Ofloxacin 30 Quinolones 92 0.33 0.09 0.06 4.24
Diltiazem hydrochloride 2,393 Calcium-channel blockers 18,431 0.13 0.05 0.02 4.18
Capsaicin 366 Rubefacients, topical NSAIDS, capsaicin and poultice 2,062 0.18 0.05 0.03 4.17
Felbinac 4 Rubefacients, topical NSAIDS, capsaicin and poultice 2,062 0.00 0.00 0.00 4.14

Prescribing where Darwen PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine gluconate 14 Mouth-washes, gargles and dentifrices 22 0.64 0.98 0.05 -7.50
Ciprofloxacin 60 Quinolones 92 0.65 0.86 0.08 -2.49
Mirabegron 305 Drugs for urinary frequency enuresis and incontinence 3,256 0.09 0.23 0.06 -2.45
Indapamide 1,105 Thiazides and related diuretics 6,095 0.18 0.42 0.10 -2.41
Salbutamol 10,566 Selective beta(2)-agonists 12,697 0.83 0.90 0.03 -2.28
Tamsulosin hydrochloride 2,386 Drugs for urinary retention 2,856 0.84 0.92 0.04 -2.24
Sodium picosulfate 0 Bowel cleansing preparations 3 0.00 0.70 0.35 -2.04
    Paracetamol 3,460 Non-opioid analgesics and compound preparations 15,259 0.23 0.50 0.13 -2.03
    Estradiol 101 Preparations for vaginal/vulval changes 375 0.27 0.56 0.15 -2.01
    Ispaghula husk 322 Bulk-forming laxatives 368 0.88 0.96 0.04 -1.99