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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Diethylamine salicylate 311 Rubefacients, topical NSAIDS, capsaicin and poultice 1,034 0.30 0.02 0.04 7.02
Fosfomycin calcium 1 Urinary-tract infections 1,378 0.00 0.00 0.00 6.78
Quinagolide hydrochloride 5 Bromocriptine and other dopaminergic drugs 7 0.71 0.05 0.10 6.46
Isotretinoin 103 Oral preparations for acne 128 0.80 0.03 0.12 6.39
Omega-3-acid ethyl esters 150 Lipid-regulating drugs 21,167 0.01 0.00 0.00 5.15
Fesoterodine fumarate 344 Drugs for urinary frequency enuresis and incontinence 2,273 0.15 0.03 0.03 4.90
Gluten free/low protein grains/flours 14 Foods for special diets 651 0.02 0.00 0.00 4.00
Dronedarone hydrochloride 71 Drugs for arrhythmias 448 0.16 0.02 0.04 3.92
Flavoxate hydrochloride 28 Drugs for urinary frequency enuresis and incontinence 2,273 0.01 0.00 0.00 3.77
Cyclizine lactate 117 Drugs used in nausea and vertigo 1,867 0.06 0.01 0.01 3.77

Prescribing where Hailsham PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-cyprindiol (Cyprote acetate/ethinylestradiol) 25 Oral preparations for acne 128 0.20 0.97 0.12 -6.39
Cabergoline 1 Bromocriptine and other dopaminergic drugs 7 0.14 0.85 0.16 -4.38
Fluconazole 91 Triazole antifungals 143 0.64 0.86 0.07 -3.35
Tacrolimus 53 Drugs affecting the immune response 108 0.49 0.80 0.11 -2.91
Terbinafine hydrochloride 61 Other antifungals 64 0.95 0.99 0.02 -2.48
Azathioprine 155 Antiproliferative immunosuppressants 271 0.57 0.80 0.10 -2.24
Beclometasone dipropionate 2,326 Corticosteroids (respiratory) 6,308 0.37 0.57 0.09 -2.18
Fluorometholone 0 Corticosteroids 252 0.00 0.09 0.05 -1.74
    Glycopyrronium bromide 15 Antimuscarinic drugs 88 0.17 0.78 0.36 -1.67
    Lamotrigine 671 Control of epilepsy 9,166 0.07 0.11 0.03 -1.59