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Prototype Prescribing Outlier Dashboard for North Norfolk 2 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 North Norfolk 2 PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pericyazine 1,590 Antipsychotic drugs 8,003 0.20 0.00 0.02 11.95
Low protein cereals 24 Foods for special diets 314 0.08 0.00 0.01 11.83
Meptazinol hydrochloride 1,163 Opioid analgesics 13,537 0.09 0.00 0.01 8.24
Freeze sprays and gels 5 Rubefacients, topical NSAIDS, capsaicin and poultice 3,842 0.00 0.00 0.00 6.17
Perindopril erbumine 15,359 Angiotensin-converting enzyme inhibitors 31,448 0.49 0.09 0.08 5.13
Eflornithine monohydrate chloride 52 Shampoos and some other scalp preparations 533 0.10 0.02 0.02 4.04
Glipizide 143 Sulfonylureas 4,572 0.03 0.00 0.01 4.02
Diamorphine hydrochloride (Systemic) 70 Opioid analgesics 13,537 0.01 0.00 0.00 3.60
Low protein cooking aids 3 Foods for special diets 314 0.01 0.00 0.00 3.43
Indacaterol maleate 41 Selective beta(2)-agonists 13,367 0.00 0.00 0.00 3.05

Prescribing where North Norfolk 2 PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Somatropin 1 Hypothalamic & anterior pituitary hormone & antioestrogens 5 0.20 0.89 0.25 -2.75
Ramipril 10,827 Angiotensin-converting enzyme inhibitors 31,448 0.34 0.70 0.14 -2.60
Ispaghula husk 793 Bulk-forming laxatives 933 0.85 0.96 0.04 -2.57
Midazolam hydrochloride 14 Drugs used in status epilepticus 38 0.37 0.79 0.17 -2.46
Losartan potassium 2,315 Angiotensin-II receptor antagonists 15,411 0.15 0.50 0.16 -2.25
Fusidic acid 205 Antibacterial preparations also used systemically 367 0.56 0.75 0.09 -2.15
Miconazole nitrate 60 Antifungal preparations 579 0.10 0.27 0.08 -2.14
Chloramphenicol 389 Antibacterials 570 0.68 0.80 0.06 -1.93
Dexamethasone 46 Use of corticosteroids 5,320 0.01 0.03 0.01 -1.84
Prednisolone 46 Copound haemorrhoidal preparations with corticosteroid 426 0.11 0.44 0.18 -1.79