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Prototype Prescribing Outlier Dashboard for Cannock Villages 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 Cannock Villages PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Insulin glulisine 526 Short-acting insulins 2,107 0.25 0.03 0.04 5.43
Ibuprofen lysine 23 Non-steroidal anti-inflammatory drugs 5,975 0.00 0.00 0.00 4.69
Betaine anhydrous 1 Drugs used in metabolic disorders 1 1.00 0.05 0.21 4.44
Hamamalis 11 Other anti-inflammatory preparations 521 0.02 0.00 0.00 4.26
Eletriptan 80 Treatment of acute migraine 1,837 0.04 0.01 0.01 4.10
Almotriptan 124 Treatment of acute migraine 1,837 0.07 0.01 0.01 4.10
Miconazole nitrate 487 Antifungal preparations 888 0.55 0.27 0.08 3.58
Sildenafil(Vasodilator Antihypertensive) 36 Vasodilator antihypertensive drugs 154 0.23 0.02 0.06 3.49
Bupivacaine hydrochloride 104 Local anaesthetics 875 0.12 0.01 0.03 3.37
Lanthanum carbonate 24 Phosphate binding agents 56 0.43 0.07 0.11 3.17

Prescribing where Cannock Villages PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Insulin aspart 1,116 Short-acting insulins 2,107 0.53 0.79 0.09 -3.07
Mupirocin 5 Antibacterial preparations only used topically 80 0.06 0.68 0.23 -2.71
Carbimazole 315 Antithyroid drugs 384 0.82 0.93 0.04 -2.61
Ketoconazole 221 Shampoos and some other scalp preparations 708 0.31 0.50 0.08 -2.27
Diazepam 1,787 Anxiolytics 2,869 0.62 0.76 0.08 -1.78
Clotrimazole 230 Antifungal preparations 888 0.26 0.44 0.11 -1.70
Terbinafine hydrochloride 54 Antifungal preparations 888 0.06 0.14 0.05 -1.70
Ivermectin 29 Topical preparation for rosacea 42 0.69 0.89 0.11 -1.70
Lymecycline 311 Tetracyclines 2,863 0.11 0.24 0.08 -1.65
Hydralazine hydrochloride 91 Vasodilator antihypertensive drugs 154 0.59 0.86 0.17 -1.59