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Prototype Prescribing Outlier Dashboard for North Solihull 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 Solihull PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Indoramin 7 Alpha-adrenoceptor blocking drugs 6,157 0.00 0.00 0.00 25.85
Vericiguat 1 Vasodilator antihypertensive drugs 65 0.02 0.00 0.00 24.98
Clomethiazole edisilate 13 Hypnotics 5,364 0.00 0.00 0.00 6.61
Glycopyrronium bromide 1,868 Antimuscarinic bronchodilators 5,608 0.33 0.06 0.08 3.25
Vancomycin hydrochloride 10 Some other antibacterials 64 0.16 0.03 0.04 3.05
Atomoxetine hydrochloride 290 CNS Stimulants and drugs used for ADHD 1,417 0.20 0.07 0.05 2.68
Nystatin 3 Vaginal and vulval infections 1,039 0.00 0.00 0.00 2.57
Leuprorelin acetate 350 Prostate cancer and gonadorelin analogues 530 0.66 0.25 0.17 2.39
Prasugrel 304 Antiplatelet drugs 27,386 0.01 0.00 0.00 2.38
Frovatriptan 137 Treatment of acute migraine 2,512 0.05 0.02 0.02 2.34

Prescribing where North Solihull PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Warfarin sodium 80 Oral anticoagulants 11,890 0.01 0.23 0.08 -2.74
Ketoconazole 395 Shampoos and some other scalp preparations 1,193 0.33 0.50 0.08 -2.05
Clotrimazole 198 Antifungal preparations 841 0.24 0.44 0.11 -1.92
Codeine phosphate 91 Cough suppressants 232 0.39 0.77 0.20 -1.90
Atropine sulfate 11 Mydriatics and cycloplegics 30 0.37 0.75 0.22 -1.77
Tiotropium bromide 2,619 Antimuscarinic bronchodilators 5,608 0.47 0.71 0.14 -1.67
Hyoscine 22 Drugs used in nausea and vertigo 6,189 0.00 0.02 0.01 -1.51
Oxycodone hydrochloride 678 Opioid analgesics 19,543 0.03 0.08 0.03 -1.44
Vitamin E 5 Vitamin E 19 0.26 0.73 0.33 -1.43
Esomeprazole 652 Proton pump inhibitors 58,217 0.01 0.03 0.02 -1.41