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Prototype Prescribing Outlier Dashboard for NHS Blackburn With Darwen CCG

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 CCGs. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given CCG 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 CCG's chemical:subparagraph ratios is provided, with this CCG'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 NHS Blackburn With Darwen CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Insulin glargine/lixisenatide 68 Intermediate and long-acting insulins 9,282 0.01 0.00 0.00 9.45
Felbinac 22 Rubefacients, topical NSAIDS, capsaicin and poultice 12,577 0.00 0.00 0.00 8.14
Salicylic acid 4 Drugs for oral ulceration and inflammation 872 0.00 0.00 0.00 6.15
Co-danthrusate (Dantron/docusate sodium) 6 Stimulant laxatives 9,363 0.00 0.00 0.00 5.81
Canagliflozin/metformin 251 Other antidiabetic drugs 37,114 0.01 0.00 0.00 4.36
Pramipexole 2,257 Dopaminergic drugs used in parkinsonism 6,158 0.37 0.13 0.05 4.30
Fluticasone propionate (Nasal) 3,570 Drugs used in nasal allergy 10,362 0.34 0.13 0.05 4.14
Testosterone esters 139 Male sex hormones and antagonists 4,612 0.03 0.01 0.00 4.03
Salbutamol 87 Compound bronchodilator preparations 1,553 0.06 0.01 0.01 3.74
Dicycloverine hydrochloride compound preparations 111 Antispasmodic and other drugs altering gut motility 10,763 0.01 0.00 0.00 3.56

Prescribing where NHS Blackburn With Darwen CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tamsulosin hydrochloride 10,063 Drugs for urinary retention 12,000 0.84 0.92 0.03 -2.93
Ketoconazole 622 Shampoos and some other scalp preparations 1,940 0.32 0.48 0.06 -2.74
Rifampicin 3 Antituberculosis drugs 16 0.19 0.73 0.21 -2.55
Mirabegron 1,958 Drugs for urinary frequency enuresis and incontinence 14,717 0.13 0.22 0.04 -2.51
Ispaghula husk 1,792 Bulk-forming laxatives 1,988 0.90 0.97 0.03 -2.47
Procyclidine hydrochloride 1,544 Antimuscarinic drugs used in parkinsonism 2,088 0.74 0.87 0.05 -2.47
Allopurinol 9,283 Gout and cytotoxic induced hyperiuicaemia 10,713 0.87 0.91 0.02 -2.46
Lamotrigine 4,922 Control of epilepsy 65,081 0.08 0.11 0.01 -2.30
Fluconazole 943 Triazole antifungals 1,222 0.77 0.86 0.04 -2.29
Duloxetine hydrochloride 2,257 Other antidepressant drugs 33,309 0.07 0.16 0.04 -2.28