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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Quinapril hydrochloride with diuretic 5 Angiotensin-converting enzyme inhibitors 9,588 0.00 0.00 0.00 10.29
Other osmotic laxative preparations 1 Osmotic laxatives 2,044 0.00 0.00 0.00 9.43
Low protein biscuits 27 Foods for special diets 287 0.09 0.01 0.01 7.28
Pridinol mesilate 11 Skeletal muscle relaxants 414 0.03 0.00 0.00 6.12
Squill 1 Expectorant and demulcent cough preparations 14 0.07 0.00 0.01 5.79
Tazarotene 1 Preparations for psoriasis 280 0.00 0.00 0.00 5.62
Methyldopa 6 Centrally-acting antihypertensive drugs 7 0.86 0.15 0.13 5.27
Benzylpenicillin sodium (Penicillin G) 1 Benzylpenicillin and phenoxymethylpenicillin 471 0.00 0.00 0.00 5.26
Oxcarbazepine 173 Control of epilepsy 7,658 0.02 0.00 0.00 5.07
Magnesium citrate 40 Magnesium 51 0.78 0.07 0.15 4.79

Prescribing where Richmond PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenoxymethylpenicillin (Penicillin V) 470 Benzylpenicillin and phenoxymethylpenicillin 471 1.00 1.00 0.00 -5.26
Carbimazole 217 Antithyroid drugs 270 0.80 0.93 0.04 -2.99
Moxonidine 1 Centrally-acting antihypertensive drugs 7 0.14 0.69 0.19 -2.80
Gabapentin 569 Control of epilepsy 7,658 0.07 0.23 0.06 -2.63
Desogestrel 546 Oral progestogen-only contraceptives 631 0.87 0.94 0.03 -2.58
Sildenafil (Erectile Dysfunction) 628 Drugs for erectile dysfunction 975 0.64 0.76 0.05 -2.24
Simple 10 Expectorant and demulcent cough preparations 14 0.71 0.96 0.12 -1.96
Neomycin sulfate 105 Nasal preparations for infection 150 0.70 0.83 0.07 -1.93
Donepezil hydrochloride 569 Drugs for dementia 2,097 0.27 0.48 0.11 -1.91
Valproic acid 28 Drugs used for mania and hypomania 412 0.07 0.38 0.18 -1.76