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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Quinapril hydrochloride 148 Angiotensin-converting enzyme inhibitors 27,945 0.01 0.00 0.00 16.21
Tinidazole 2 Metronidazole, tinidazole and ornidazole 204 0.01 0.00 0.00 14.07
Fluticasone propionate (Topical) 34 Topical corticosteroids 5,120 0.01 0.00 0.00 7.32
Teicoplanin 9 Some other antibacterials 80 0.11 0.00 0.02 6.94
Fulvestrant 11 Breast cancer 1,240 0.01 0.00 0.00 5.21
Phosphates 2 Bowel cleansing preparations 7 0.29 0.01 0.06 4.97
Diflucortolone valerate 15 Topical corticosteroids 5,120 0.00 0.00 0.00 4.71
Celiprolol hydrochloride 94 Beta-adrenoceptor blocking drugs 22,415 0.00 0.00 0.00 4.55
Guaifenesin 1 Expectorant and demulcent cough preparations 2 0.50 0.03 0.11 4.27
Pitolisant hydrochloride 6 CNS Stimulants and drugs used for ADHD 877 0.01 0.00 0.00 4.19

Prescribing where Fosseway PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Metronidazole 202 Metronidazole, tinidazole and ornidazole 204 0.99 1.00 0.00 -14.07
Simple 1 Expectorant and demulcent cough preparations 2 0.50 0.96 0.12 -3.68
Amoxicillin 3,009 Broad-spectrum penicillins 4,138 0.73 0.85 0.05 -2.31
Clarithromycin 336 Macrolides 928 0.36 0.58 0.12 -1.91
Menthol 7 Topical local anaesthetics and antipruritics 53 0.13 0.47 0.17 -1.90
Omeprazole 9,161 Proton pump inhibitors 37,071 0.25 0.51 0.15 -1.74
Fluticasone propionate (Inhalation) 814 Corticosteroids (respiratory) 11,764 0.07 0.18 0.06 -1.73
Estradiol with progestogen 589 Oestrogens and Hormone Replacement Therapy 2,272 0.26 0.38 0.07 -1.72
Umeclidinium bromide/vilanterol 40 Compound bronchodilator preparations 563 0.07 0.50 0.25 -1.72
Hyoscine butylbromide 466 Antispasmodic and other drugs altering gut motility 2,019 0.23 0.33 0.06 -1.64