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Prototype Prescribing Outlier Dashboard for Haringey - North East 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 Haringey - North East PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium clodronate 61 Bisphosphonates and other drugs 2,236 0.03 0.00 0.00 9.94
Emulsifying wax 640 Emollients 3,263 0.20 0.01 0.02 9.41
Magnesium citrate 2 Bowel cleansing preparations 2 1.00 0.03 0.12 7.86
Budesonide 340 Drugs used in nasal allergy 3,546 0.10 0.01 0.01 7.14
Squill 4 Expectorant and demulcent cough preparations 56 0.07 0.00 0.01 5.79
Entacapone 104 Dopaminergic drugs used in parkinsonism 1,339 0.08 0.01 0.01 5.73
Atomoxetine hydrochloride 176 CNS Stimulants and drugs used for ADHD 536 0.33 0.07 0.05 5.22
Selegiline hydrochloride 57 Dopaminergic drugs used in parkinsonism 1,339 0.04 0.01 0.01 4.85
Iron carboxymaltose 1 Parenteral iron 1 1.00 0.05 0.21 4.57
Tetracycline 18 Tetracyclines 699 0.03 0.01 0.00 4.45

Prescribing where Haringey - North East PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other emollient preparations 2,378 Emollients 3,263 0.73 0.89 0.04 -3.73
Terbinafine hydrochloride 84 Other antifungals 90 0.93 0.99 0.02 -3.71
Alginic acid compound preparations 1,891 Compound Alginates and proprietary indigestion preparations 1,938 0.98 1.00 0.01 -3.44
Potassium permanganate 1 Oxidisers and dyes 3 0.33 0.94 0.19 -3.20
Pregabalin 1,550 Control of epilepsy 15,856 0.10 0.27 0.06 -3.08
Estradiol 41 Preparations for vaginal/vulval changes 303 0.14 0.56 0.15 -2.93
Methotrexate 338 Rheumatic disease suppressant drugs 1,178 0.29 0.58 0.11 -2.72
Iron dextran 0 Parenteral iron 1 0.00 0.87 0.33 -2.67
    Fluconazole 99 Triazole antifungals 143 0.69 0.86 0.07 -2.50
    Fexofenadine hydrochloride 1,098 Antihistamines 8,622 0.13 0.35 0.09 -2.49