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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Xylometazoline hydrochloride/ipratropium bromide 3 Topical nasal decongestants 78 0.04 0.00 0.00 20.19
Quinidine sulfate 7 Drugs for arrhythmias 679 0.01 0.00 0.00 13.17
Calcitriol 398 Vitamin D 19,142 0.02 0.00 0.00 7.89
Urine testing reagents 441 Diabetic diagnostic and monitoring agents 5,191 0.08 0.01 0.01 6.12
Cariprazine 28 Antipsychotic drugs 9,586 0.00 0.00 0.00 4.74
Silver nitrate 18 Preparations for warts and calluses 50 0.36 0.07 0.08 3.45
Benzydamine hydrochloride 6 Rubefacients, topical NSAIDS, capsaicin and poultice 3,860 0.00 0.00 0.00 3.21
Hydrocort sodiumphos 38 Antibacterials 659 0.06 0.01 0.02 2.83
Gluten free breads 304 Foods for special diets 600 0.51 0.15 0.13 2.73
Ipratropium bromide 66 Topical nasal decongestants 78 0.85 0.36 0.18 2.71

Prescribing where Northwich PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium chloride 8 Topical nasal decongestants 78 0.10 0.54 0.18 -2.48
Glucose blood testing reagents 4,596 Diabetic diagnostic and monitoring agents 5,191 0.89 0.94 0.02 -2.42
Other food for special diet preparations 153 Foods for special diets 600 0.26 0.64 0.17 -2.27
Furosemide 7,890 Loop diuretics 11,337 0.70 0.85 0.07 -2.19
Sodium picosulfate 0 Bowel cleansing preparations 1 0.00 0.70 0.35 -2.04
    Prednisolone 4,607 Use of corticosteroids 5,548 0.83 0.89 0.03 -2.00
    Peppermint oil 157 Antispasmodic and other drugs altering gut motility 4,390 0.04 0.12 0.04 -1.92
    Light liquid paraffin 23 Emollient bath and shower preparations 254 0.09 0.33 0.13 -1.91
    Oral rehydration salts 56 Oral sodium and water 174 0.32 0.65 0.20 -1.67
    Rivaroxaban 1,552 Oral anticoagulants 20,178 0.08 0.24 0.10 -1.60